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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

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Affiliated Author(s)
허승호
Alternative Author(s)
Hur, Seung Ho
Journal Title
Coronary Artery Disease
ISSN
1473-5830
Issued Date
2019
Keyword
multivessel diseaserevascularizationST-elevation myocardial infarction
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, logrank 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.
Department
Dept. of Internal Medicine (내과학)
Publisher
School of Medicine (의과대학)
Citation
Sung Gyun Ahn et al. (2019). 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. Coronary Artery Disease, 30(2), 95–102. doi: 10.1097/MCA.0000000000000684
Type
Article
ISSN
1473-5830
DOI
10.1097/MCA.0000000000000684
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/41921
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Internal Medicine (내과학)
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