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

Sung Gyun Ahn, Jun Won Lee, Dae Ryong Kang, Hye Sim Kim, Tae Hwa Go, Min Heui Yu, Ju Han Kim, Myung Ho Jung, Jong Seon Park, Shung Chull Chae, Myeng Chan Cho, Chong Jin Kim, Hyeon Cheol Gwon, Hyo Soo Kim, Ki Bae Seung, Kwang Soo Cha, Jei Keon Chae, Seung Jae Joo, Seung Woon Rha, Dong Ju ChoiSeung Ho Hur, In Whan Seong, Doo Il Kim, Seok Kyu Oh, Tae Hoon Ahn, Jin Yong Hwang, Junghan Yoon

    Research output: Contribution to journalArticlepeer-review

    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.

    Original languageEnglish
    Pages (from-to)95-102
    Number of pages8
    JournalCoronary artery disease
    Volume30
    Issue number2
    DOIs
    Publication statusPublished - 2019 Mar 1

    Bibliographical note

    Funding Information:
    This research was supported by a fund (2016-ER6304-01) by Research of Korea Centers for Disease Control and Prevention. The electronic CRF development and data management for this study was performed using iCReaT (internet-based Clinical Research and Trial management system), a data management system established by Centers for Disease Control and Prevention, Ministry of Health and Welfare, Republic of Korea (iCReaT Study No. C110016).

    Publisher Copyright:
    © 2018 Wolters Kluwer Health, Inc.

    Keywords

    • ST-elevation myocardial infarction
    • multivessel disease
    • revascularization

    ASJC Scopus subject areas

    • Cardiology and Cardiovascular Medicine

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