Comparison of Outcomes of Staged Complete Revascularization Versus Culprit Lesion–Only Revascularization for ST-Elevation Myocardial Infarction and Multivessel Coronary Artery Disease

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

The management of noninfarct-related arteries in patients with ST-elevation myocardial infarction (STEMI) and multivessel coronary disease (MVD) is still debated. We evaluated the prognostic impact of staged complete revascularization with percutaneous coronary intervention (PCI) in STEMI patients with MVD admitted to our hospital from 2005 to 2013. Patients undergoing staged complete revascularization (n = 300) were compared with 1:1 propensity score–matched patients with culprit lesion–only treatment (n = 300). We considered a composite primary end point of all-cause death, myocardial infarction, and urgent PCI. Secondary end points included components of the primary, cardiovascular death, any PCI excluding staged PCI. We also performed an analysis including only patients surviving at least 5 days. The median follow-up was 553 days. The primary end point occurred in 10.3% of patients in the staged complete revascularization group and in 16.3% of patients in the culprit lesion–only group (hazard ratio 0.61, 95% CI 0.38 to 0.95, p = 0.031). Although this difference was no longer significant when considering only the survivors at day 5, all-cause and cardiovascular mortalities were still reduced in the staged complete revascularization group. Complete revascularization was associated with a better outcome (hazard ratio 0.35, 95% CI 0.17 to 0.63, p = 0.005) if performed within 30 days of STEMI. In conclusion, compared with culprit lesion–only revascularization, in STEMI patients with MVD undergoing primary PCI, an approach of staged complete revascularization was associated with a better outcome.

Original languageEnglish
Pages (from-to)508-514
Number of pages7
JournalAmerican Journal of Cardiology
Volume119
Issue number4
DOIs
Publication statusPublished - Feb 15 2017

Fingerprint

Coronary Artery Disease
Percutaneous Coronary Intervention
Coronary Disease
ST Elevation Myocardial Infarction
Survivors
Cause of Death
Arteries
Myocardial Infarction
Mortality

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

@article{b406680ff2014a96937797ac379b81d1,
title = "Comparison of Outcomes of Staged Complete Revascularization Versus Culprit Lesion–Only Revascularization for ST-Elevation Myocardial Infarction and Multivessel Coronary Artery Disease",
abstract = "The management of noninfarct-related arteries in patients with ST-elevation myocardial infarction (STEMI) and multivessel coronary disease (MVD) is still debated. We evaluated the prognostic impact of staged complete revascularization with percutaneous coronary intervention (PCI) in STEMI patients with MVD admitted to our hospital from 2005 to 2013. Patients undergoing staged complete revascularization (n = 300) were compared with 1:1 propensity score–matched patients with culprit lesion–only treatment (n = 300). We considered a composite primary end point of all-cause death, myocardial infarction, and urgent PCI. Secondary end points included components of the primary, cardiovascular death, any PCI excluding staged PCI. We also performed an analysis including only patients surviving at least 5 days. The median follow-up was 553 days. The primary end point occurred in 10.3{\%} of patients in the staged complete revascularization group and in 16.3{\%} of patients in the culprit lesion–only group (hazard ratio 0.61, 95{\%} CI 0.38 to 0.95, p = 0.031). Although this difference was no longer significant when considering only the survivors at day 5, all-cause and cardiovascular mortalities were still reduced in the staged complete revascularization group. Complete revascularization was associated with a better outcome (hazard ratio 0.35, 95{\%} CI 0.17 to 0.63, p = 0.005) if performed within 30 days of STEMI. In conclusion, compared with culprit lesion–only revascularization, in STEMI patients with MVD undergoing primary PCI, an approach of staged complete revascularization was associated with a better outcome.",
author = "Marcello Marino and Gabriele Crimi and Sergio Leonardi and Marco Ferlini and Alessandra Repetto and Rita Camporotondo and Andrea Demarchi and {De Pascali}, Ilaria and Francesca Falcinella and {Oltrona Visconti}, Luigi and {De Servi}, Stefano and Maurizio Ferrario and {De Ferrari}, {Gaetano Maria} and Massimiliano Gnecchi",
year = "2017",
month = "2",
day = "15",
doi = "10.1016/j.amjcard.2016.10.040",
language = "English",
volume = "119",
pages = "508--514",
journal = "American Journal of Cardiology",
issn = "0002-9149",
publisher = "Elsevier Inc.",
number = "4",

}

TY - JOUR

T1 - Comparison of Outcomes of Staged Complete Revascularization Versus Culprit Lesion–Only Revascularization for ST-Elevation Myocardial Infarction and Multivessel Coronary Artery Disease

AU - Marino, Marcello

AU - Crimi, Gabriele

AU - Leonardi, Sergio

AU - Ferlini, Marco

AU - Repetto, Alessandra

AU - Camporotondo, Rita

AU - Demarchi, Andrea

AU - De Pascali, Ilaria

AU - Falcinella, Francesca

AU - Oltrona Visconti, Luigi

AU - De Servi, Stefano

AU - Ferrario, Maurizio

AU - De Ferrari, Gaetano Maria

AU - Gnecchi, Massimiliano

PY - 2017/2/15

Y1 - 2017/2/15

N2 - The management of noninfarct-related arteries in patients with ST-elevation myocardial infarction (STEMI) and multivessel coronary disease (MVD) is still debated. We evaluated the prognostic impact of staged complete revascularization with percutaneous coronary intervention (PCI) in STEMI patients with MVD admitted to our hospital from 2005 to 2013. Patients undergoing staged complete revascularization (n = 300) were compared with 1:1 propensity score–matched patients with culprit lesion–only treatment (n = 300). We considered a composite primary end point of all-cause death, myocardial infarction, and urgent PCI. Secondary end points included components of the primary, cardiovascular death, any PCI excluding staged PCI. We also performed an analysis including only patients surviving at least 5 days. The median follow-up was 553 days. The primary end point occurred in 10.3% of patients in the staged complete revascularization group and in 16.3% of patients in the culprit lesion–only group (hazard ratio 0.61, 95% CI 0.38 to 0.95, p = 0.031). Although this difference was no longer significant when considering only the survivors at day 5, all-cause and cardiovascular mortalities were still reduced in the staged complete revascularization group. Complete revascularization was associated with a better outcome (hazard ratio 0.35, 95% CI 0.17 to 0.63, p = 0.005) if performed within 30 days of STEMI. In conclusion, compared with culprit lesion–only revascularization, in STEMI patients with MVD undergoing primary PCI, an approach of staged complete revascularization was associated with a better outcome.

AB - The management of noninfarct-related arteries in patients with ST-elevation myocardial infarction (STEMI) and multivessel coronary disease (MVD) is still debated. We evaluated the prognostic impact of staged complete revascularization with percutaneous coronary intervention (PCI) in STEMI patients with MVD admitted to our hospital from 2005 to 2013. Patients undergoing staged complete revascularization (n = 300) were compared with 1:1 propensity score–matched patients with culprit lesion–only treatment (n = 300). We considered a composite primary end point of all-cause death, myocardial infarction, and urgent PCI. Secondary end points included components of the primary, cardiovascular death, any PCI excluding staged PCI. We also performed an analysis including only patients surviving at least 5 days. The median follow-up was 553 days. The primary end point occurred in 10.3% of patients in the staged complete revascularization group and in 16.3% of patients in the culprit lesion–only group (hazard ratio 0.61, 95% CI 0.38 to 0.95, p = 0.031). Although this difference was no longer significant when considering only the survivors at day 5, all-cause and cardiovascular mortalities were still reduced in the staged complete revascularization group. Complete revascularization was associated with a better outcome (hazard ratio 0.35, 95% CI 0.17 to 0.63, p = 0.005) if performed within 30 days of STEMI. In conclusion, compared with culprit lesion–only revascularization, in STEMI patients with MVD undergoing primary PCI, an approach of staged complete revascularization was associated with a better outcome.

UR - http://www.scopus.com/inward/record.url?scp=85008354472&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85008354472&partnerID=8YFLogxK

U2 - 10.1016/j.amjcard.2016.10.040

DO - 10.1016/j.amjcard.2016.10.040

M3 - Article

C2 - 28007297

AN - SCOPUS:85008354472

VL - 119

SP - 508

EP - 514

JO - American Journal of Cardiology

JF - American Journal of Cardiology

SN - 0002-9149

IS - 4

ER -