Immediate multivessel intervention versus culprit-vessel intervention only in patients with ST-elevation myocardial infarction and multivessel coronary disease: data from the prospective KAMIR-NIH registry
- Authors
- Ahn, Sung Gyun; Lee, Jun-Won; Kang, Dae Ryong; Kim, Hye Sim; Go, Tae-Hwa; Yu, Min Heui; Kim, Ju Han; Jun, Myung Ho; Park, Jong-Seon; Chae, Shung Chull; Cho, Myeng-Chan; Kim, Chong Jin; Gwon, Hyeon-Cheol; Kim, Hyo-Soo; Seung, Ki Bae; Cha, Kwang Soo; Chae, Jei Keon; Joo, Seung Jae; Rha, Seung Woon; Choi, Dong-Ju; Hur, Seung Ho; Seong, In Whan; Kim, Doo Il; Oh, Seok Kyu; Ahn, Tae Hoon; Hwang, Jin Yong; Yoon, Junghan
- Issue Date
- 3월-2019
- Publisher
- LIPPINCOTT WILLIAMS & WILKINS
- Keywords
- multivessel disease; revascularization; ST-elevation myocardial infarction
- Citation
- CORONARY ARTERY DISEASE, v.30, no.2, pp.95 - 102
- Indexed
- SCIE
SCOPUS
- Journal Title
- CORONARY ARTERY DISEASE
- Volume
- 30
- Number
- 2
- Start Page
- 95
- End Page
- 102
- URI
- https://scholar.korea.ac.kr/handle/2021.sw.korea/67078
- DOI
- 10.1097/MCA.0000000000000684
- ISSN
- 0954-6928
- Abstract
- Background The safety and efficacy of immediate multivessel coronary intervention (MVI) remain controversial in patients with ST-elevation myocardial infarction (STEMI) and multivessel disease (MVD). This study aimed to investigate the clinical outcomes of immediate MVI compared with culprit-vessel intervention only (CVI-O) in diverse subgroups with STEMI and MVD. Patients and methods We compared immediate MVI (n = 260) and CVI-O (n = 931) regarding 1-year major adverse cardiac event rates for cardiac death, recurrent myocardial infarction (MI), and repeat revascularization in 1191 STEMI patients with MVD using data from the Korea Acute Myocardial Infarction-National Institutes of Health registry (2011-2015). High-risk patients and those who underwent a staged procedure were excluded from the analysis. Furthermore, propensity score matching and stratified subgroup analyses were performed. Results Immediate MVI and CVI-O groups had similar 1-year major adverse cardiac event rates [7.7 vs. 8.9%, hazard ratio (HR): 0.86, 95% confidence interval (CI): 0.50-1.47, log-rank P = 0.5628]. No difference was found between the groups in terms of the 1-year rate of cardiac death (2.9 vs. 1.3%, HR: 2.24, 95% CI: 0.75-6.67) or recurrent MI (2 vs. 1.5%, HR: 1.41, 95% CI: 0.45-4.44). However, repeat revascularization occurred less frequently in the immediate MVI group than in the CVI-O group (2.0 vs. 5.7%, HR: 0.35, 95% CI: 0.13-0.90, log-rank P = 0.0142). These findings were found to be consistent across a broad spectrum of subgroups. Conclusion Compared with CVI-O, immediate MVI did not improve 1-year net clinical outcomes in stable STEMI patients with MVD. The only benefit found was a reduced repeat revascularization in immediate MVI. Copyright (c) 2018 Wolters Kluwer Health, Inc. All rights reserved.
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