Multivessel versus IRA-only PCI in patients with NSTEMI and severe left ventricular systolic dysfunction

Myunhee Lee; Dae Won Kim; Mahn Won Park; Kyusup Lee; Sung Ho Her; Kiyuk Chang; Wook Sung Chung; Myung Ho Jeong; Seung Woon Rha; Hyo Soo Kim; Hyeon Cheol Gwon; In Whan Seong; Kyung Kuk Hwang; Shung Chull Chae; Kwon Bae Kim; Young Jo Kim; Kwang Soo Cha; Seok Kyu Oh; Jei Keon Chae; Ji Hoon Jung

doi:10.1371/journal.pone.0258525

Multivessel versus IRA-only PCI in patients with NSTEMI and severe left ventricular systolic dysfunction

Myunhee Lee, Dae Won Kim, Mahn Won Park, Kyusup Lee, Sung Ho Her, Kiyuk Chang, Wook Sung Chung, Myung Ho Jeong, Seung Woon Rha, Hyo Soo Kim, Hyeon Cheol Gwon, In Whan Seong, Kyung Kuk Hwang, Shung Chull Chae, Kwon Bae Kim, Young Jo Kim, Kwang Soo Cha, Seok Kyu Oh, Jei Keon Chae, Ji Hoon Jung

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Abstract

Background A substantial number of patients presenting with non-ST-elevation myocardial infarction (NSTEMI) and multivessel disease (MVD) have severe left ventricular systolic dysfunction (LVSD) (left ventricular ejection fraction (LVEF) less than 35%). But data are lacking regarding optimal percutaneous coronary intervention (PCI) strategy for these patients. The aim of this study was to compare the long-term outcomes of IRA (infarct-related artery)-only and multivessel PCI in patients with NSTEMI and MVD complicated by severe LVSD. Methods Among 13,104 patients enrolled in the PCI registry from November 2011 to December 2015, patients with NSTEMI and MVD with severe LVSD who underwent successful PCI were screened. The primary outcome was 3-year major adverse cardiovascular events (MACEs), defined as all-cause death, any myocardial infarction, stroke, and any revascularization. Results Overall, 228 patients were treated with IRA-only PCI (n = 104) or MV-PCI (n = 124). The MACE risk was significantly lower in the MV-PCI group than in the IRA-only PCI group (35.5% vs. 54.8%; hazard ratio [HR] 0.561; 95% confidence interval [CI] 0.378–0.832; p = 0.04). This result was mainly driven by a significantly lower risk of all-cause death (23.4% vs. 41.4%; hazard ratio [HR] 0.503; 95% confidence interval [CI] 0.314–0.806; p = 0.004). The results were consistent after multivariate regression, propensity-score matching, and inverse probability weighting to adjust for baseline differences. Conclusions Among patients with NSTEMI and MVD complicated with severe LVSD, multivessel PCI was associated with a significantly lower MACE risk. The findings may provide valuable information to physicians who are involved in decision-making for these patients.

Original language	English
Article number	e0258525
Journal	PloS one
Volume	16
Issue number	10 October
DOIs	https://doi.org/10.1371/journal.pone.0258525
Publication status	Published - 2021 Oct

Bibliographical note

Funding Information:
Funding: This research was supported by funding (2016-ER6304-02) from the Research of Korea Centers for Disease Control and Prevention. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Publisher Copyright:
Copyright: © 2021 Lee et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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Lee, M., Kim, D. W., Park, M. W., Lee, K., Her, S. H., Chang, K., Chung, W. S., Jeong, M. H., Rha, S. W., Kim, H. S., Gwon, H. C., Seong, I. W., Hwang, K. K., Chae, S. C., Kim, K. B., Kim, Y. J., Cha, K. S., Oh, S. K., Chae, J. K., & Jung, J. H. (2021). Multivessel versus IRA-only PCI in patients with NSTEMI and severe left ventricular systolic dysfunction. PloS one, 16(10 October), Article e0258525. https://doi.org/10.1371/journal.pone.0258525

Lee, M, Kim, DW, Park, MW, Lee, K, Her, SH, Chang, K, Chung, WS, Jeong, MH, Rha, SW, Kim, HS, Gwon, HC, Seong, IW, Hwang, KK, Chae, SC, Kim, KB, Kim, YJ, Cha, KS, Oh, SK, Chae, JK & Jung, JH 2021, 'Multivessel versus IRA-only PCI in patients with NSTEMI and severe left ventricular systolic dysfunction', PloS one, vol. 16, no. 10 October, e0258525. https://doi.org/10.1371/journal.pone.0258525

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title = "Multivessel versus IRA-only PCI in patients with NSTEMI and severe left ventricular systolic dysfunction",

abstract = "Background A substantial number of patients presenting with non-ST-elevation myocardial infarction (NSTEMI) and multivessel disease (MVD) have severe left ventricular systolic dysfunction (LVSD) (left ventricular ejection fraction (LVEF) less than 35%). But data are lacking regarding optimal percutaneous coronary intervention (PCI) strategy for these patients. The aim of this study was to compare the long-term outcomes of IRA (infarct-related artery)-only and multivessel PCI in patients with NSTEMI and MVD complicated by severe LVSD. Methods Among 13,104 patients enrolled in the PCI registry from November 2011 to December 2015, patients with NSTEMI and MVD with severe LVSD who underwent successful PCI were screened. The primary outcome was 3-year major adverse cardiovascular events (MACEs), defined as all-cause death, any myocardial infarction, stroke, and any revascularization. Results Overall, 228 patients were treated with IRA-only PCI (n = 104) or MV-PCI (n = 124). The MACE risk was significantly lower in the MV-PCI group than in the IRA-only PCI group (35.5% vs. 54.8%; hazard ratio [HR] 0.561; 95% confidence interval [CI] 0.378–0.832; p = 0.04). This result was mainly driven by a significantly lower risk of all-cause death (23.4% vs. 41.4%; hazard ratio [HR] 0.503; 95% confidence interval [CI] 0.314–0.806; p = 0.004). The results were consistent after multivariate regression, propensity-score matching, and inverse probability weighting to adjust for baseline differences. Conclusions Among patients with NSTEMI and MVD complicated with severe LVSD, multivessel PCI was associated with a significantly lower MACE risk. The findings may provide valuable information to physicians who are involved in decision-making for these patients.",

author = "Myunhee Lee and Kim, {Dae Won} and Park, {Mahn Won} and Kyusup Lee and Her, {Sung Ho} and Kiyuk Chang and Chung, {Wook Sung} and Jeong, {Myung Ho} and Rha, {Seung Woon} and Kim, {Hyo Soo} and Gwon, {Hyeon Cheol} and Seong, {In Whan} and Hwang, {Kyung Kuk} and Chae, {Shung Chull} and Kim, {Kwon Bae} and Kim, {Young Jo} and Cha, {Kwang Soo} and Oh, {Seok Kyu} and Chae, {Jei Keon} and Jung, {Ji Hoon}",

note = "Funding Information: Funding: This research was supported by funding (2016-ER6304-02) from the Research of Korea Centers for Disease Control and Prevention. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Publisher Copyright: Copyright: {\textcopyright} 2021 Lee et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.",

year = "2021",

month = oct,

doi = "10.1371/journal.pone.0258525",

language = "English",

volume = "16",

journal = "PloS one",

issn = "1932-6203",

publisher = "Public Library of Science",

number = "10 October",

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TY - JOUR

T1 - Multivessel versus IRA-only PCI in patients with NSTEMI and severe left ventricular systolic dysfunction

AU - Lee, Myunhee

AU - Kim, Dae Won

AU - Park, Mahn Won

AU - Lee, Kyusup

AU - Her, Sung Ho

AU - Chang, Kiyuk

AU - Chung, Wook Sung

AU - Jeong, Myung Ho

AU - Rha, Seung Woon

AU - Kim, Hyo Soo

AU - Gwon, Hyeon Cheol

AU - Seong, In Whan

AU - Hwang, Kyung Kuk

AU - Chae, Shung Chull

AU - Kim, Kwon Bae

AU - Kim, Young Jo

AU - Cha, Kwang Soo

AU - Oh, Seok Kyu

AU - Chae, Jei Keon

AU - Jung, Ji Hoon

N1 - Funding Information: Funding: This research was supported by funding (2016-ER6304-02) from the Research of Korea Centers for Disease Control and Prevention. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Publisher Copyright: Copyright: © 2021 Lee et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

PY - 2021/10

Y1 - 2021/10

N2 - Background A substantial number of patients presenting with non-ST-elevation myocardial infarction (NSTEMI) and multivessel disease (MVD) have severe left ventricular systolic dysfunction (LVSD) (left ventricular ejection fraction (LVEF) less than 35%). But data are lacking regarding optimal percutaneous coronary intervention (PCI) strategy for these patients. The aim of this study was to compare the long-term outcomes of IRA (infarct-related artery)-only and multivessel PCI in patients with NSTEMI and MVD complicated by severe LVSD. Methods Among 13,104 patients enrolled in the PCI registry from November 2011 to December 2015, patients with NSTEMI and MVD with severe LVSD who underwent successful PCI were screened. The primary outcome was 3-year major adverse cardiovascular events (MACEs), defined as all-cause death, any myocardial infarction, stroke, and any revascularization. Results Overall, 228 patients were treated with IRA-only PCI (n = 104) or MV-PCI (n = 124). The MACE risk was significantly lower in the MV-PCI group than in the IRA-only PCI group (35.5% vs. 54.8%; hazard ratio [HR] 0.561; 95% confidence interval [CI] 0.378–0.832; p = 0.04). This result was mainly driven by a significantly lower risk of all-cause death (23.4% vs. 41.4%; hazard ratio [HR] 0.503; 95% confidence interval [CI] 0.314–0.806; p = 0.004). The results were consistent after multivariate regression, propensity-score matching, and inverse probability weighting to adjust for baseline differences. Conclusions Among patients with NSTEMI and MVD complicated with severe LVSD, multivessel PCI was associated with a significantly lower MACE risk. The findings may provide valuable information to physicians who are involved in decision-making for these patients.

AB - Background A substantial number of patients presenting with non-ST-elevation myocardial infarction (NSTEMI) and multivessel disease (MVD) have severe left ventricular systolic dysfunction (LVSD) (left ventricular ejection fraction (LVEF) less than 35%). But data are lacking regarding optimal percutaneous coronary intervention (PCI) strategy for these patients. The aim of this study was to compare the long-term outcomes of IRA (infarct-related artery)-only and multivessel PCI in patients with NSTEMI and MVD complicated by severe LVSD. Methods Among 13,104 patients enrolled in the PCI registry from November 2011 to December 2015, patients with NSTEMI and MVD with severe LVSD who underwent successful PCI were screened. The primary outcome was 3-year major adverse cardiovascular events (MACEs), defined as all-cause death, any myocardial infarction, stroke, and any revascularization. Results Overall, 228 patients were treated with IRA-only PCI (n = 104) or MV-PCI (n = 124). The MACE risk was significantly lower in the MV-PCI group than in the IRA-only PCI group (35.5% vs. 54.8%; hazard ratio [HR] 0.561; 95% confidence interval [CI] 0.378–0.832; p = 0.04). This result was mainly driven by a significantly lower risk of all-cause death (23.4% vs. 41.4%; hazard ratio [HR] 0.503; 95% confidence interval [CI] 0.314–0.806; p = 0.004). The results were consistent after multivariate regression, propensity-score matching, and inverse probability weighting to adjust for baseline differences. Conclusions Among patients with NSTEMI and MVD complicated with severe LVSD, multivessel PCI was associated with a significantly lower MACE risk. The findings may provide valuable information to physicians who are involved in decision-making for these patients.

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U2 - 10.1371/journal.pone.0258525

DO - 10.1371/journal.pone.0258525

M3 - Article

C2 - 34644362

AN - SCOPUS:85117174651

SN - 1932-6203

VL - 16

JO - PloS one

JF - PloS one

IS - 10 October

M1 - e0258525

ER -

Multivessel versus IRA-only PCI in patients with NSTEMI and severe left ventricular systolic dysfunction

Abstract

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