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 journalArticle

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

Keywords

  • multivessel disease
  • revascularization
  • ST-elevation myocardial infarction

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Ahn, S. G., Lee, J. W., Kang, D. R., Kim, H. S., Go, T. H., Yu, M. H., Kim, J. H., Jung, M. H., Park, J. S., Chae, S. C., Cho, M. C., Kim, C. J., Gwon, H. C., Kim, H. S., Seung, K. B., Cha, K. S., Chae, J. K., Joo, S. J., Rha, S-W., ... Yoon, J. (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. https://doi.org/10.1097/MCA.0000000000000684