Culprit-Lesion-Only Versus Multivessel Revascularization Using Drug-Eluting Stents in Patients With ST-Segment Elevation Myocardial Infarction: A Korean Acute Myocardial Infarction Registry-Based Analysis

Background and Objectives In patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease, complete revascularization (CR) for non-culprit lesions is not routinely recommended. The aim of this study was to compare the clinical outcomes of multivessel compared with infarct-related artery (IRA)-only revascularization in patients undergoing primary percutaneous coronary intervention (PCI) for STEMI. Subjects and Methods From the Korean Acute Myocardial Infarction Registry (KAMIR) database, 1,094 STEMI patients with multivessel disease who underwent primary PCI with drug-eluting stents were enrolled in this study. The patients were divided into two groups: culprit-vessel-only revascularization (COR, n=827) group; multivessel revascularization, including non-IRA (MVR, n=267) group. The primary endpoint of this study included major adverse cardiac events (MACEs), such as death, myocardial infarction, or target or nontarget lesion revascularization at one year. Results There was no difference in clinical characteristics between the two groups. During the one-year follow-up, 102 (15.2%) patients in the COR group and 32 (14.2%) in the MVR group experienced at least one MACE (p=0.330). There were no differences between the two groups in terms of rates of death, myocardial infarction, or revascularization (2.1% vs. 2.0%, 0.7% vs. 0.8%, and 11.7% vs. 10.1%, respectively; p=0.822, 0.910, and 0.301, respectively). The MACE rate was higher in the incompletely revascularized patients than in the completely revascularized patients (15% vs. 9.5%, p=0.039), and the difference was attributable to a higher rate of nontarget vessel revascularization (8.6% vs. 1.8%, p=0.002). Conclusion Although multivessel angioplasty during primary PCI for STEMI did not reduce the MACE rate compared with culprit-vessel-only PCI, CR was associated with a lower rate of repeat revascularization after multivessel PCI.

[1]  Fred S Apple,et al.  Universal definition of myocardial infarction. , 2007, Journal of the American College of Cardiology.

[2]  Min Chul Kim,et al.  What is optimal revascularization strategy in patients with multivessel coronary artery disease in non-ST-elevation myocardial infarction? Multivessel or culprit-only revascularization. , 2011, International journal of cardiology.

[3]  J. Cho,et al.  Impact of the Metabolic Syndrome on the Clinical Outcome of Patients with Acute ST-Elevation Myocardial Infarction , 2010, Journal of Korean medical science.

[4]  Jae-Seok Hong,et al.  Long-Term Trend in the Incidence of Acute Myocardial Infarction in Korea: 1997-2007 , 2009, Korean circulation journal.

[5]  G. Sangiorgi,et al.  A randomised trial of target-vessel versus multi-vessel revascularisation in ST-elevation myocardial infarction: major adverse cardiac events during long-term follow-up , 2009, Heart.

[6]  Sunil V. Rao,et al.  Prevalence, predictors, and in-hospital outcomes of non-infarct artery intervention during primary percutaneous coronary intervention for ST-segment elevation myocardial infarction (from the National Cardiovascular Data Registry). , 2009, The American journal of cardiology.

[7]  Ju Han Kim,et al.  Differences in Clinical Outcomes Between Patients With ST-Elevation Versus Non-ST-Elevation Acute Myocardial Infarction in Korea , 2009, Korean circulation journal.

[8]  M. Jeong,et al.  N-terminal pro-B-type natriuretic peptide is associated with adverse short-term clinical outcomes in patients with acute ST-elevation myocardial infarction underwent primary percutaneous coronary intervention. , 2009, International journal of cardiology.

[9]  F. Veglia,et al.  Contrast Volume During Primary Percutaneous Coronary Intervention and Subsequent Contrast-Induced Nephropathy and Mortality , 2009, Annals of Internal Medicine.

[10]  J. Cho,et al.  Gender differences of success rate of percutaneous coronary intervention and short term cardiac events in Korea Acute Myocardial Infarction Registry. , 2008, International journal of cardiology.

[11]  M. Jeong,et al.  Clinical safety of drug-eluting stents in the Korea acute myocardial infarction registry. , 2008, Circulation journal : official journal of the Japanese Circulation Society.

[12]  P. Serruys,et al.  Clinical End Points in Coronary Stent Trials: A Case for Standardized Definitions , 2007, Circulation.

[13]  E. Topol,et al.  Outcome of multivessel coronary intervention in the contemporary percutaneous revascularization era. , 2006, The American journal of cardiology.

[14]  Lippincott Williams Wilkins,et al.  ACC/AHA/SCAI Practice Guidelines, February 21, 2006 , 2006 .

[15]  J. Ornato,et al.  ACC/AHA/SCAI 2005 guideline update for percutaneous coronary intervention: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/SCAI Writing Committee to Update 2001 Guidelines for Percutaneous Coronary Intervention). , 2006, Circulation.

[16]  G. Parodi,et al.  Five year outcome after primary coronary intervention for acute ST elevation myocardial infarction: results from a single centre experience , 2005, Heart.

[17]  P. Serruys,et al.  Complete versus culprit vessel percutaneous coronary intervention in multivessel disease: a randomized comparison. , 2004, American heart journal.

[18]  C. W. Barth,et al.  Multivessel percutaneous coronary intervention in patients with multivessel disease and acute myocardial infarction. , 2004, American heart journal.

[19]  G. Lamas,et al.  ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction--executive summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to revise the 1999 guidelines for the management of patients wi , 2004, Journal of the American College of Cardiology.

[20]  C. Grines,et al.  Initial experience with multivessel percutaneous coronary intervention during mechanical reperfusion for acute myocardial infarction. , 2001, The American journal of cardiology.

[21]  I. Schmoelzer,et al.  Multiple complex coronary plaques in patients with acute myocardial infarction. , 2001, The New England journal of medicine.

[22]  M. Leon,et al.  Procedural results and late clinical outcomes following multivessel coronary stenting. , 1998, Journal of the American College of Cardiology.

[23]  J. Moses,et al.  Long-term angiographic and clinical outcome of patients undergoing multivessel coronary stenting. , 1997, Circulation.

[24]  K. Lee,et al.  Multivessel coronary artery disease: a key predictor of short-term prognosis after reperfusion therapy for acute myocardial infarction. Thrombolysis and Angioplasty in Myocardial Infarction (TAMI) Study Group. , 1991, American heart journal.

[25]  S. Ellis,et al.  Angiographic and clinical predictors of acute closure after native vessel coronary angioplasty. , 1988, Circulation.

[26]  Deepak L. Bhatt,et al.  Culprit-only or multivessel revascularization in patients with acute coronary syndromes: an American College of Cardiology National Cardiovascular Database Registry report. , 2008, American heart journal.

[27]  G. Pasterkamp,et al.  Multiple complex coronary plaques in patients with acute myocardial infarction. , 2001, The New England journal of medicine.