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Culprit vessel percutaneous coronary intervention versus multivessel and staged percutaneous coronary intervention for ST-segment elevation myocardial infarction patients with multivessel disease.

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Year: 2009 Volume: 2

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Culprit vessel percutaneous coronary intervention versus multivessel and staged percutaneous coronary intervention for ST-segment elevation myocardial infarction patients with multivessel disease.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Hannan, Edward L. Samadashvili, Zaza Walford, Gary Holmes, David R. Jacobs, Alice K. Stamato, Nicholas J. Venditti, Ferdinand J. Sharma, Samin King, Spencer B.
Spatial Coverage	New York
Description	Country affiliation: United States Author Affiliation: Hannan EL ( School of Public Health, University at Albany, State University of New York, Albany, New York 12144-3456, USA. elh03@health.state.ny.us)
Abstract	OBJECTIVES: The purpose of this study was to examine the differences in in-hospital and longer-term mortality for ST-segment elevation myocardial infarction (STEMI) patients with multivessel disease as a function of whether they underwent single-vessel (culprit vessel) percutaneous coronary interventions (PCIs) or multivessel PCI. BACKGROUND: The optimal treatment of patients with STEMI and multivessel disease is of continuing interest in the era of drug-eluting stents. METHODS: STEMI patients with multivessel disease undergoing PCIs in New York between January 1, 2003, and June 30, 2006, were subdivided into those who underwent culprit vessel PCI and those who underwent multivessel PCI during the index procedure, during the index admission, or staged within 60 days of the index admission. Patients were propensity-matched and mortality rates were calculated at 12, 24, and 42 months. RESULTS: A total of 3,521 patients (87.5%) underwent culprit vessel PCI during the index procedure. A total of 259 of them underwent staged PCI during the index admission and 538 patients underwent staged PCI within 60 days of the index procedure. For patients without hemodynamic compromise, culprit vessel PCI during the index procedure was associated with lower in-hospital mortality than multivessel PCI during the index procedure (0.9% vs. 2.4%, p = 0.04). Patients undergoing staged multivessel PCI within 60 days after the index procedure had a significantly lower 12-month mortality rate than patients undergoing culprit vessel PCI only (1.3% vs. 3.3%, p = 0.04). CONCLUSIONS: Our findings support the American College of Cardiology/American Heart Association (ACC/AHA) recommendation that culprit vessel PCI be used for STEMI patients with multivessel disease at the time of the index PCI when patients are not hemodynamically compromised. However, staged PCI within 60 days after the index procedure, including during the index admission, is associated with risk-adjusted mortality rates that are comparable with the rate for culprit vessel PCI alone.
File Format	HTM / HTML
ISSN	19368798
Issue Number	1
Volume Number	3
e-ISSN	18767605
Journal	JACC: Cardiovascular Interventions
Language	English
Publisher	Elsevier
Publisher Date	2010-01-01
Publisher Place	United States
Access Restriction	One Nation One Subscription (ONOS)
Subject Keyword	Therapy Comparative Study Humans Middle Aged Male Epidemiology Journal Article Angioplasty, Balloon, Coronary Patient Selection Time Factors Etiology Discipline Cardiology Female Registries Severity Of Illness Index New York Adverse Effects Hospital Mortality Risk Assessment Complications Mortality Risk Factors Treatment Outcome Coronary Artery Disease Aged, 80 And Over Physiopathology Propensity Score Myocardial Infarction Practice Guidelines As Topic Multicenter Study Aged Hemodynamics Methods
Content Type	Text
Resource Type	Article
Subject	Cardiology and Cardiovascular Medicine

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