Abstract 12615: Angina Frequency and Unplanned Readmissions after Multivessel vs. Culprit Vessel Only Percutaneous Coronary Intervention Strategy Among Patients Presenting With Acute Myocardial Infarction- 6 Week Outcomes From the TRANSLATE-ACS Observational Study
Background: While many patients with acute myocardial infarction (MI) have multivessel disease, it is unclear whether these patients should undergo single vessel (i.e., culprit only) or multivessel percutaneous coronary intervention (PCI). We used data from the TRANSLATE-ACS study to examine the association of an initial multivessel vs. single vessel PCI strategy with subsequent angina frequency and risk for readmission.
Methods: We examined 6,050 PCI-treated acute MI patients with multivessel disease in the TRANSLATE-ACS study. Inverse probability weighting (IPW) with proportional odds modeling was used to study the association between single vs. multivessel intervention and 6 week angina frequency. After excluding planned and staged revascularizations, we studied the association of unplanned all-cause readmission at 6-weeks and intervention strategy using IPW adjusted Cox proportional hazards modeling.
Results: Multivessel PCI was performed in 1,208 patients (20%). Relative to single vessel intervention, patients receiving multivessel PCI were similarly aged, but were more likely to be female (29% vs. 24%), have diabetes (34% vs. 31%), present with cardiogenic shock (3.3% vs. 1.9%), and less likely to present with STEMI (32% vs. 53%) (p<0.05 for all). Frequency of angina at 6-week follow-up was similar between multivessel and single vessel PCI groups in both unadjusted (no angina 72.2% vs. 70.8%; monthly 21.9% vs. 22.7%; daily/weekly 5.9% vs. 6.6% respectively, p=0.61) and risk-adjusted analyses (adjusted OR 0.95, 95% CI 0.82 1.10, p=0.55). In contrast, initial multivessel PCI was associated with fewer unplanned all-cause readmissions at 6-weeks (Figure) as compared with single vessel only PCI (adjusted HR 0.83, 95% CI 0.70-0.99).
Conclusion: Among acute MI patients with multivessel disease, those treated with multivessel PCI had similar angina frequency but fewer unplanned readmissions at 6-weeks compared with single vessel only PCI.
Author Disclosures: P.K. Sharma: Ownership Interest; Significant; Co-Founder InnovaHeart LLC. D.J. Cohen: Speakers Bureau; Modest; Astra Zeneca, Eli Lily. Consultant/Advisory Board; Modest; Astra Zeneca, Eli Lilly, Medtronic, Abbott Vascular. Research Grant; Significant; Medtronic, Edwards Lifesciences, Abbott Vascular, Boston Scientific, Eli Lilly, Daiichi Sankyo, Astra Zeneca, Merck, Biomet, Cardiovascular Systems, Inc.. G.C. Fonarow: None. L.A. McCoy: None. M.B. Effron: Employment; Significant; Eli Lilly and Company. Ownership Interest; Significant; Eli Lilly and Company. E. Petersen: Research Grant; Significant; ) Eli Lilly & Company, Janssen Pharmaceutical. Consultant/Advisory Board; Modest; Janssen Pharmaceutical, Merck & Co. Sanofi-Aventis. Consultant/Advisory Board; Significant; Boehringer Ingelheim. T.Y. Wang: Research Grant; Significant; Lilly USA, Daiichi Sankyo, Gilead Science, GlaxoSmith Kline, American College of Cardiology, American Society of Nuclear Cardiology. Honoraria; Modest; Astra Zeneca. Honoraria; Significant; American College of Cardiology Foundation.
- © 2014 by American Heart Association, Inc.