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 Choi & 7 others Seung 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

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Coronary Disease
Registries
Confidence Intervals
Myocardial Infarction
Propensity Score
National Institutes of Health (U.S.)
Korea
ST Elevation Myocardial Infarction
Safety

Keywords

  • multivessel disease
  • revascularization
  • ST-elevation myocardial infarction

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

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

In: Coronary artery disease, Vol. 30, No. 2, 01.03.2019, p. 95-102.

Research output: Contribution to journalArticle

Ahn, SG, Lee, JW, Kang, DR, Kim, HS, Go, TH, Yu, MH, Kim, JH, Jung, MH, Park, JS, Chae, SC, Cho, MC, Kim, CJ, Gwon, HC, Kim, HS, Seung, KB, Cha, KS, Chae, JK, Joo, SJ, Rha, S-W, Choi, DJ, Hur, SH, Seong, IW, Kim, DI, Oh, SK, Ahn, TH, Hwang, JY & 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, vol. 30, no. 2, pp. 95-102. https://doi.org/10.1097/MCA.0000000000000684
Ahn, Sung Gyun ; Lee, Jun Won ; Kang, Dae Ryong ; Kim, Hye Sim ; Go, Tae Hwa ; Yu, Min Heui ; Kim, Ju Han ; Jung, Myung Ho ; Park, Jong Seon ; Chae, Shung Chull ; Cho, Myeng Chan ; Kim, Chong Jin ; Gwon, Hyeon Cheol ; Kim, Hyo Soo ; Seung, Ki Bae ; Cha, Kwang Soo ; Chae, Jei Keon ; Joo, Seung Jae ; Rha, Seung-Woon ; Choi, Dong Ju ; Hur, Seung Ho ; Seong, In Whan ; Kim, Doo Il ; Oh, Seok Kyu ; Ahn, Tae Hoon ; Hwang, Jin Yong ; Yoon, Junghan. / 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. In: Coronary artery disease. 2019 ; Vol. 30, No. 2. pp. 95-102.
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title = "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",
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.",
keywords = "multivessel disease, revascularization, ST-elevation myocardial infarction",
author = "Ahn, {Sung Gyun} and Lee, {Jun Won} and Kang, {Dae Ryong} and Kim, {Hye Sim} and Go, {Tae Hwa} and Yu, {Min Heui} and Kim, {Ju Han} and Jung, {Myung Ho} and Park, {Jong Seon} and Chae, {Shung Chull} and Cho, {Myeng Chan} and Kim, {Chong Jin} and Gwon, {Hyeon Cheol} and Kim, {Hyo Soo} and Seung, {Ki Bae} and Cha, {Kwang Soo} and Chae, {Jei Keon} and Joo, {Seung Jae} and Seung-Woon Rha and Choi, {Dong Ju} and Hur, {Seung Ho} and Seong, {In Whan} and Kim, {Doo Il} and Oh, {Seok Kyu} and Ahn, {Tae Hoon} and Hwang, {Jin Yong} and Junghan Yoon",
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TY - JOUR

T1 - Immediate multivessel intervention versus culprit-vessel intervention only in patients with ST-elevation myocardial infarction and multivessel coronary disease

T2 - Data from the prospective KAMIR-NIH registry

AU - Ahn, Sung Gyun

AU - Lee, Jun Won

AU - Kang, Dae Ryong

AU - Kim, Hye Sim

AU - Go, Tae Hwa

AU - Yu, Min Heui

AU - Kim, Ju Han

AU - Jung, Myung Ho

AU - Park, Jong Seon

AU - Chae, Shung Chull

AU - Cho, Myeng Chan

AU - Kim, Chong Jin

AU - Gwon, Hyeon Cheol

AU - Kim, Hyo Soo

AU - Seung, Ki Bae

AU - Cha, Kwang Soo

AU - Chae, Jei Keon

AU - Joo, Seung Jae

AU - Rha, Seung-Woon

AU - Choi, Dong Ju

AU - Hur, Seung Ho

AU - Seong, In Whan

AU - Kim, Doo Il

AU - Oh, Seok Kyu

AU - Ahn, Tae Hoon

AU - Hwang, Jin Yong

AU - Yoon, Junghan

PY - 2019/3/1

Y1 - 2019/3/1

N2 - 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.

AB - 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.

KW - multivessel disease

KW - revascularization

KW - ST-elevation myocardial infarction

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U2 - 10.1097/MCA.0000000000000684

DO - 10.1097/MCA.0000000000000684

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EP - 102

JO - Coronary Artery Disease

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