Abstract 5611: Mortality after Acute Non-Culprit Coronary Intervention in STEMI: Insights from APEX AMI
Current guidelines strongly discourage the performance of percutaneous coronary intervention (PCI) on non-culprit vessels at the time of primary PCI for ST-elevation myocardial infarction (STEMI). Few data have examined this question. The Assessment of Pexelizumab in Acute Myocardial Infarction (APEX-AMI) trial did not demonstrate a pexelizumab treatment effect in 5,745 STEMI patients who were to undergo primary PCI. We examined the incidence of and propensity for non-culprit interventions performed at the time of the primary PCI and its association with 90-day death. Of the 5,373 patients who underwent primary PCI, 238 (4.4%) underwent non-culprit PCI. Overall, 84 patients had shock or CHF prior to the intervention: 4.2% in those undergoing non-culprit PCI vs. 1.4% with culprit-only PCI (p=0.003). Factors associated with undergoing non-culprit PCI included older age, multi-vessel coronary artery disease, non-inferior MI, and longer ischemic time. Higher 90-day mortality was associated non-culprit PCI (Figure⇓, p (log-rank) <0.001); this relationship persisted after multivariable and propensity adjustment (HR 1.88, 95%CI 1.24 –2.87, p=0.003). Performing PCI of a non-infarct-related coronary artery at the time of the acute PCI procedure in STEMI patients carries an incremental risk. Our findings reinforce current guidelines that discourage performing such procedures in uncomplicated STEMI patients.