Abstract 9443: Long-Term Clinical Outcomes of Infarct-Related Artery versus Multivessel Revascularization in Acute ST-Segment Elevation Myocardial Infarction with Multivessel Disease: An Analysis from Korea Acute Myocardial Infarction Registry
Many STEMI patients have multivessel disease. Guidelines recommend multiple revascularization only in cardiogenic shock. We compared clinical outcomes of multivessel revascularization with infarct-related artery(IRA) revascularization in ST-segment myocardial infarction(STEMI) patients.
The 1,283 STEMI patients with multivessel disease[975 in IRA group(group I), 308 in multivessel group(group II)] received primary PCI and were analyzed from a nationwide Korea Acute Myocardial Infarction Registry. Primary outcomes were in-hospital mortality and 12-month major adverse cardiac events(MACE, defined as death, myocardial infarction, and repeated revascularization). Secondary outcomes were in-hospital complications and components of the MACE. There were more hemodynamic unstable patients in group I. In-hospital mortality was higher in group I with marginal significance(6.6% vs. 3.6%, p = 0.051). 12-month MACE occurred in 84(14.6%) in group I, 20(11.5%) in group II(p = 0.294). Each components of MACE were occurred similarly in two groups but non-target vessel revascularization(6.4% vs. 1.7%, p = 0.012). Adjusting for confounding factors, multivessel revascularization did not reduce in-hospital mortality(OR 0.935, 95% CI 0.403-2.167, p=0.875). It was same for 12-month MACE(OR 0.953, 95% CI 0.406-2.233, p = 0.911) and secondary outcomes. But multivessel revascularization reduced non-target vessel revascularization(OR 0.279, 95% CI 0.085-0.922, p = 0.036).
There was no significant difference of clinical outcomes except for low risk of non-target vessel revascularization in multivessel revascularization group. Therefore, results of our study support current guidelines.
- © 2011 by American Heart Association, Inc.