Abstract 12134: Treatment of Multi-Vessel Coronary Artery Disease (CAD) in Primary Percutaneous Coronary Intervention (PPCI) for ST segment Elevation Myocardial Infarction (STEMI): Culprit Only Revascularization is Associated with Higher Major Adverse Cardiovascular Event (MACE) Rates
Background: Multivessel disease occurs in 40-65% of patients undergoing PPCI for STEMI and is associated with poor prognosis. Guidelines recommend treating the culprit artery alone during PPCI. There is limited data comparing outcomes of complete versus infarct-related artery (IRA) -only revascularisation in PPCI for STEMI with few studies including later date elective PCI for staged revascularisation. We aimed to identify MACE in patients with multivessel disease undergoing PPCI dependent on management strategy.
Method: Information was analysed from a prospective database on 2131 STEMI patients undergoing PPCI between 2004-2010 at a London centre. Outcome assessed by all-cause mortality provided by the BCIS/CCAD national audit. Patients were split into 3 different groups: culprit vessel only angioplasty (COR); staged revascularisation (SR) and simultaneous treatment of non-IRA (CR). Primary end point used was MACE defined as death, myocardial infarction (MI), stroke and target vessel revascularization (TVR).
Results: 963 (45%) patients with STEMI & multivessel CAD underwent PPCI. There were similar baseline characteristics between the 3 groups, aside from cardiogenic shock which was significantly higher in the complete revascularisation group. At 30 days follow up, 9% of patients in the COR group experienced at least one MACE, 1% in the SR group and 5% in the CR group, p=0.01. This trend continued up to 1 year follow up with the lowest event rate in the SR group. After 3 years MACE rates significantly increased in the COR group (24%) but were similar in the CR (18%) and SR (17%) groups. MACE rates were driven mainly by death in CR group with high rates of TVR in the COR and SR groups.
Conclusions: Culprit vessel-only angioplasty was associated with the highest rate of long-term MACE compared with multivessel treatment. Patients scheduled for staged revascularisation experienced a similar rate of MACE to patients undergoing complete simultaneous treatment of non-IRA.
- Percutaneous coronary intervention
- Myocardial infarction, STEMI
- Coronary artery disease
- © 2011 by American Heart Association, Inc.