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Single or multivessel percutaneous coronary intervention in ST‐elevation myocardial infarction patients
Author(s) -
Varani Elisabetta,
Balducelli Marco,
Aquilina Matteo,
Vecchi Giuseppe,
Hussien Mohamed Naseem,
Frassineti Valeria,
Maresta Aleardo
Publication year - 2008
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.21722
Subject(s) - medicine , percutaneous coronary intervention , cardiology , myocardial infarction , elevation (ballistics) , st elevation , geometry , mathematics
Objectives: To evaluate clinical results of percutaneous coronary intervention (PCI) in ST‐elevation myocardial infarction (STEMI) in patients with multivessel disease (MVD), in relation to single or multivessel (MV)‐PCI and to patients with single vessel disease (SVD). Methods: Patients treated with PCI in the setting of <24 hr STEMI in the years 2004–2007 were considered. Results: Seven hundred forty‐five primary PCI, 346 (46%) in patients with SVD and 399 (54%) in patients with MVD were performed. Among MVD patients, 156 (39%) had infarct related artery (IRA)‐only treatment and 243 had MV‐PCI: 147 (37%) in a single session, 48 (12%) within 24 hr, and 48 (12%) predischarge. Revascularization was complete in 46% of MVD patients. At a median follow‐up of 597 days, mortality was 6.3% in SVD and 12% in MVD ( P = 0.007), new revascularization 2.9% and 9%, respectively ( P < 0.001). Thirty‐day mortality was 2.4% in SVD and 6.7% in MVD ( P = 0.006). After exclusion of patients with cardiogenic shock or pulmonary oedema, more frequent in the MV‐PCI in single session group ( P = 0.006), 30‐day mortality was SVD 1.3%, IRA‐only 6.3%, MV‐PCI 2.8% ( P = 0.023), without differences if in a single (3.3%) or in staged session (2.2%). By multivariate analysis, female sex, anterior STEMI, cardiogenic shock, MVD, and procedural failure were independent predictors of 30‐day mortality. Conclusions: STEMI patients with MVD have a worse prognosis than those with SVD. MV‐PCI in patients without hemodynamic compromise yields good short‐term results, even if performed very early, with a 30‐day mortality in between that of SVD patients and that of MVD patients with IRA‐only treatment. © 2008 Wiley‐Liss, Inc.