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Rawat A, Nazly S, Kumar J, Khan TJ, Kaur K, Kaur G, Batool S, Khan A. Comparison of Immediate Versus Staged Complete Revascularisation in Patients Presenting With Acute Coronary Syndrome and Multivessel Disease: A Meta-Analysis of Randomized and Non-randomized Studies. Cureus 2023; 15:e43968. [PMID: 37746472 PMCID: PMC10515466 DOI: 10.7759/cureus.43968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2023] [Indexed: 09/26/2023] Open
Abstract
Acute myocardial infarction is a critical medical condition that poses a significant health burden, leading to substantial morbidity. Despite advancements in medical care, managing this condition is challenging for patients and society. The preferred approach appears to be comprehensive multivessel revascularization, yet the optimal timing remains uncertain. This study aims to compare immediate complete revascularisation and stage complete vascularization in patients presenting with acute coronary syndrome (ACS) and multivessel coronary artery disease (MVD). The Preferred Reporting of Systematic Reviews and Meta-analysis (PRISMA) guidelines conducted the present meta-analysis. A comprehensive literature search was conducted using online databases, including PubMed, and EMBASE from 2010 onwards, to identify articles that compared cardiovascular outcomes between patients undergoing immediate and staged complete revascularization. We also searched Google Scholar for additional studies relevant to the present meta-analysis. The primary outcome assessed in this study was major adverse cardiovascular events (MACE). Secondary outcomes included all-cause mortality, cardiovascular mortality, myocardial infarction (MI), and revascularization. A total of 15 studies fulfilled pre-defined eligibility criteria and were included in the final analysis. Our analysis shows that staged revascularization is associated with improved outcomes in patients with ACS and multivessel CAD, including all-cause mortality and cardiovascular mortality, without increasing the risk of major adverse cardiovascular events, myocardial infarction, and the need for unplanned revascularization.
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Affiliation(s)
- Anurag Rawat
- Interventional Cardiology, Himalayan Institute of Medical Sciences, Baksar Wala, IND
| | - Sumreen Nazly
- Internal Medicine, University Medical & Dental College Faisalabad, Faisalabad, PAK
| | - Jasvant Kumar
- Internal Medicine, Chandka Medical College, Larkana, PAK
| | - Tayyaba J Khan
- Internal Medicine, Liaquat University of Medical and Health Sciences, Jamshoro, PAK
| | - Komal Kaur
- Medicine, American University of Antigua, Osburn, ATG
| | - Gurvir Kaur
- Medicine, American University of Antigua, Osburn, ATG
- Medicine, Chino Valley Medical Center, Chino, USA
| | - Saima Batool
- Internal Medicine, Hameed Latif Hospital, Lahore, PAK
| | - Areeba Khan
- Critical Care Medicine, United Medical and Dental College, Karachi, PAK
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2
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Jain C, Dash PK, Iyer VR, Deshmukh R. Culprit vessel only versus complete revascularization following thrombolysis in patients with ST elevation myocardial infraction and multivessel coronary artery disease - A prospective study. Indian Heart J 2023; 75:274-278. [PMID: 37402433 PMCID: PMC10421984 DOI: 10.1016/j.ihj.2023.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 06/28/2023] [Accepted: 06/30/2023] [Indexed: 07/06/2023] Open
Abstract
OBJECTIVE The present study compares the treatment outcomes of only culprit vessel PCI and complete revascularization in patients with STEMI and multivessel disease (MVD) following thrombolysis. METHODS This was a single-center, prospective randomized study including a total of 108 patients presenting at a tertiary care center within 3-24 h post-thrombolysis and undergoing pharmacoinvasive PCI, and randomized into two groups: complete revascularization PCI group and culprit only PCI group. The primary outcomes were evaluated by cardiac mortality, repeat myocardial infarction (MI)/acute coronary syndrome (ACS) and refractory angina. The secondary outcomes include repeat revascularization and safety outcomes namely contrast induced nephropathy (CIN), cerebrovascular accident (CVA) and major bleeding were compared among both the groups at one year follow-up. RESULTS Complete revascularization PCI group and culprit only PCI group had 54 patients in each group. Left ventricular ejection fraction did not show significant difference at discharge (p = 1) but was significantly improved in complete revascularization PCI group (p = 0.001) at one year follow-up. Reduced number of outcomes with a significant difference in both the groups were seen for primary outcomes such as cardiac mortality (p = 0.01), repeat MI/ACS (p = 0.01) and refractory angina (p = 0.038) along with repeat revascularization (p = 0.001) at one year follow-up. Complete revascularization did not show any statistically significant difference for CIN (p = 0.567), CVA (p = 0.153) and major bleeding (p = 0.322) then culprit only revascularization group. CONCLUSION In patients with STEMI and MVD, complete revascularization was found more favourable in terms of primary and secondary outcomes compared to culprit only revascularization.
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Affiliation(s)
- Chetan Jain
- Department of Cardiology, Sri Satya Sai General Hospital, Puttaparthi, Andhra Pradesh, 515134, India.
| | - P K Dash
- Department of Cardiology, Sri Satya Sai General Hospital, Puttaparthi, Andhra Pradesh, 515134, India.
| | - V R Iyer
- Department of Cardiology, Sri Satya Sai General Hospital, Puttaparthi, Andhra Pradesh, 515134, India.
| | - Rizwan Deshmukh
- Department of Cardiology, Sri Satya Sai General Hospital, Puttaparthi, Andhra Pradesh, 515134, India.
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Wang C, Lang J, Zhang J, Hu Y, Han C, Xu R, Wu J, Liu C, Li W, Li T, Wei A, Qi W, Jin D, Cong H, Wang L. Culprit vessel vs. immediate multivessel vs. out-of-hospital staged intervention for patients with non-ST-segment elevation myocardial infarction and multivessel disease. Front Cardiovasc Med 2022; 9:1033475. [PMID: 36505387 PMCID: PMC9726786 DOI: 10.3389/fcvm.2022.1033475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 11/09/2022] [Indexed: 11/24/2022] Open
Abstract
Background and aims The optimal interventional strategy remains undetermined in hemodynamically stable patients with NSTEMI and MVD. This study aimed to examine clinical prognosis among culprit vessel, immediate multivessel, and staged percutaneous coronary intervention (PCI) in patients with NSTEMI and MVD. Methods This retrospective, observational, single-center study included 943 hemodynamically stable patients with NSTEMI and MVD who had undergone successful drug-eluting stent (DES) implantation from January 2014 to December 2019. Patients were categorized into culprit lesion-only PCI (CL-PCI), immediate multivessel PCI (MV-PCI), and out-of-hospital staged MV-PCI according to PCI strategy. The primary outcome was the composite of major adverse cardiac events (MACEs), including all-cause death, myocardial infarction (MI), or unplanned repeat revascularization. The secondary outcomes were all-cause death, cardiac death, MI, and unplanned repeat revascularization. Results Over a median follow-up of 59 months, immediate MV-PCI was associated with a lower risk of all-cause death than CL-PCI (HR: 0.591, 95%CI: 0.364-0.960, P = 0.034). Out-of-hospital staged MV-PCI was associated with a reduced risk of MACE (HR: 0.448, 95%CI: 0.314-0.638, P < 0.001) and all-cause death (HR: 0.326, 95%CI: 0.183-0.584, P < 0.001) compared with CL-PCI. The above results were accordant after multivariate COX analysis and propensity score matching. MACE (HR: 0.560, 95%CI: 0.385-0.813, P = 0.002) and repeat revascularization (HR: 0.627, 95%CI: 0.400-0.982, P = 0.041) were significantly less likely to occur with out-of-hospital MV-PCI rather than immediate MV-PCI. However, the incidences of primary and secondary outcomes were comparable between immediate and staged PCI after confounder adjustment using multivariate regression and propensity score matching analysis. For subgroup analyses stratified by synergy between PCI with taxus and cardiac surgery score, staged MV-PCI was found to lower the risk of MACE compared with immediate MV-PCI in patients with more complex coronary disease. Conclusion Hemodynamically stable patients with NSTEMI and MVD benefited from the strategy of MV-PCI. Patients with complex coronary anatomy treated with out-of-hospital staged MV-PCI rather than immediate MV-PCI had lower risks of MACE. These need to be confirmed in the future randomized study.
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Affiliation(s)
- Chen Wang
- Clinical School of Thoracic, Tianjin Medical University, Tianjin, China,Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Jiachun Lang
- Clinical School of Thoracic, Tianjin Medical University, Tianjin, China,Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Jingxia Zhang
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Yuecheng Hu
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Chuyi Han
- Clinical School of Thoracic, Tianjin Medical University, Tianjin, China,Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Rongdi Xu
- Clinical School of Thoracic, Tianjin Medical University, Tianjin, China,Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Jikun Wu
- Clinical School of Thoracic, Tianjin Medical University, Tianjin, China,Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Chunwei Liu
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Wenyu Li
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Tingting Li
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Ao Wei
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Wei Qi
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Dongxia Jin
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Hongliang Cong
- Clinical School of Thoracic, Tianjin Medical University, Tianjin, China,Department of Cardiology, Tianjin Chest Hospital, Tianjin, China,*Correspondence: Hongliang Cong,
| | - Le Wang
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China,Le Wang,
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Vriesendorp PA, Wilschut JM, Diletti R, Daemen J, Kardys I, Zijlstra F, Van Mieghem NM, Bennett J, Esposito G, Sabate M, den Dekker WK. Immediate versus staged revascularisation of non-culprit arteries in patients with acute coronary syndrome: a systematic review and meta-analysis. Neth Heart J 2022; 30:449-456. [PMID: 35536483 PMCID: PMC9474746 DOI: 10.1007/s12471-022-01687-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2022] [Indexed: 12/02/2022] Open
Abstract
Although there is robust evidence that revascularisation of non-culprit vessels should be pursued in patients presenting with an acute coronary syndrome (ACS) and multivessel coronary artery disease (MVD), the optimal timing of complete revascularisation remains disputed. In this systematic review and meta-analysis our results suggest that outcomes are comparable for immediate and staged complete revascularisation in patients with ACS and MVD. However, evidence from randomised controlled trials remains scarce and cautious interpretation of these results is recommended. More non-biased evidence is necessary to aid future decision making on the optimal timing of complete revascularisation.
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Affiliation(s)
- P A Vriesendorp
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands
- The Heart Centre, The Alfred Hospital, Melbourne, Australia
| | - J M Wilschut
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - R Diletti
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - J Daemen
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - I Kardys
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - F Zijlstra
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - N M Van Mieghem
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - J Bennett
- Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven, Belgium
| | - G Esposito
- Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - M Sabate
- Cardiovascular Institute, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - W K den Dekker
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands.
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Othman F, Abid AR, AlQahtani A, Gehani A, Al Suwaidi J, Arabi A. Exaggeration of Non-Culprit Coronary Artery Stenosis in the Setting of Primary Percutaneous Coronary Intervention: A Single Center Observational Study. RESEARCH REPORTS IN CLINICAL CARDIOLOGY 2021. [DOI: 10.2147/rrcc.s280661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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6
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Complete Revascularization in Patients With STEMI and Multivessel Coronary Artery Disease: Is It Beneficial? CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2021. [DOI: 10.1007/s11936-020-00887-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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7
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Jacob R, Sachedina AK, Kumar S. Comprehensive Review of Complete Versus Culprit-only Revascularization for Multivessel Disease in ST-segment Elevation Myocardial Infarction. Heart Int 2021; 15:54-59. [DOI: 10.17925/hi.2021.15.1.54] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 07/05/2021] [Indexed: 11/24/2022] Open
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8
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Stähli BE, Varbella F, Schwarz B, Nordbeck P, Felix SB, Lang IM, Toma A, Moccetti M, Valina C, Vercellino M, Rigopoulos AG, Rohla M, Schindler M, Wischnewsky M, Linke A, Schulze PC, Richardt G, Laugwitz KL, Weidinger F, Rottbauer W, Achenbach S, Huber K, Neumann FJ, Kastrati A, Ford I, Ruschitzka F, Maier W. Rationale and design of the MULTISTARS AMI Trial: A randomized comparison of immediate versus staged complete revascularization in patients with ST-segment elevation myocardial infarction and multivessel disease. Am Heart J 2020; 228:98-108. [PMID: 32871329 DOI: 10.1016/j.ahj.2020.07.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 07/20/2020] [Indexed: 12/13/2022]
Abstract
About half of patients with acute ST-segment elevation myocardial infarction (STEMI) present with multivessel coronary artery disease (MVD). Recent evidence supports complete revascularization in these patients. However, optimal timing of non-culprit lesion revascularization in STEMI patients is unknown because dedicated randomized trials on this topic are lacking. STUDY DESIGN: The MULTISTARS AMI trial is a prospective, international, multicenter, randomized, two-arm, open-label study planning to enroll at least 840 patients. It is designed to investigate whether immediate complete revascularization is non-inferior to staged (within 19-45 days) complete revascularization in patients in stable hemodynamic conditions presenting with STEMI and MVD and undergoing primary percutaneous coronary intervention (PCI). After successful primary PCI of the culprit artery, patients are randomized in a 1:1 ratio to immediate or staged complete revascularization. The primary endpoint is a composite of all-cause death, non-fatal myocardial infarction, ischemia-driven revascularization, hospitalization for heart failure, and stroke at 1 year. CONCLUSIONS: The MULTISTARS AMI trial tests the hypothesis that immediate complete revascularization is non-inferior to staged complete revascularization in stable patients with STEMI and MVD.
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Affiliation(s)
- Barbara E Stähli
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | | | - Bettina Schwarz
- Heart Center, Segeberger Kliniken GmbH, Academic Teaching Hospital for the Universities of Kiel, Lübeck and Hamburg, Bad Segeberg, Germany
| | - Peter Nordbeck
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Stephan B Felix
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, and DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald, Germany
| | - Irene M Lang
- Department of Internal Medicine II, Cardiology, Medical University of Vienna, Vienna, Austria
| | - Aurel Toma
- Department of Internal Medicine II, Cardiology, Medical University of Vienna, Vienna, Austria
| | | | - Christian Valina
- Division of Cardiology and Angiology II, University Heart Center Freiburg - Bad Krozingen, Bad Krozingen, Germany
| | - Matteo Vercellino
- Department of Internal Medicine, Santi Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy
| | - Angelos G Rigopoulos
- Mid-German Heart Center, Department of Internal Medicine III (KIM-III), Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle, Halle, Germany
| | - Miklos Rohla
- 3rd Department of Medicine, Cardiology and Intensive Care Medicine, Wilhelminenhospital and Sigmund Freud University, Medical School, Vienna, Austria
| | - Matthias Schindler
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | | | - Axel Linke
- Technische Universität Dresden, Department of Internal Medicine and Cardiology, Herzzentrum Dresden, University Clinic, Dresden, Germany
| | - P Christian Schulze
- Department of Internal Medicine I, Division of Cardiology, Pneumology, Angiology and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University Jena, Jena, Germany
| | - Gert Richardt
- Heart Center, Segeberger Kliniken GmbH, Academic Teaching Hospital for the Universities of Kiel, Lübeck and Hamburg, Bad Segeberg, Germany
| | - Karl-Ludwig Laugwitz
- Clinic and Policlinic Internal Medicine I (Cardiology and Angiology), Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Franz Weidinger
- 2(nd) Medical Department with Cardiology and Intensive Care Medicine, Rudolfstiftung Hospital, Vienna, Austria
| | | | - Stephan Achenbach
- Department of Cardiology, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Kurt Huber
- 3rd Department of Medicine, Cardiology and Intensive Care Medicine, Wilhelminenhospital and Sigmund Freud University, Medical School, Vienna, Austria
| | - Franz-Josef Neumann
- Division of Cardiology and Angiology II, University Heart Center Freiburg - Bad Krozingen, Bad Krozingen, Germany
| | - Adnan Kastrati
- Deutsches Herzzentrum München, Technische Universität, Munich, and DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Germany
| | - Ian Ford
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, United Kingdom
| | - Frank Ruschitzka
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Willibald Maier
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland.
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9
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Percutaneous complete revascularization strategies using sirolimus-eluting biodegradable polymer-coated stents in patients presenting with acute coronary syndrome and multivessel disease: Rationale and design of the BIOVASC trial. Am Heart J 2020; 227:111-117. [PMID: 32739537 DOI: 10.1016/j.ahj.2020.06.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 06/08/2020] [Indexed: 01/24/2023]
Abstract
BACKGROUND Complete revascularization in patients with an acute coronary syndrome and multivessel disease is superior compared to culprit-only treatment. However, it is unknown whether direct complete or staged complete revascularization should be pursued. METHODS The BIOVASC study is an investigator-initiated, prospective, multicenter, randomized, 2-arm, international, open-label, noninferiority trial. We will randomize 1,525 patients 1:1 to immediate complete revascularization (experimental arm) or culprit-only plus staged complete revascularization (control arm). Patients will be enrolled in approximately 30 sites in Belgium, Italy, the Netherlands, and Spain. The primary end point is a composite of all-cause mortality, nonfatal myocardial infarction, any unplanned ischemia-driven revascularization (excluding staged procedures in the control arm at the predetermined time), and cerebrovascular events (MACCE) at 1 year post index procedure. CONCLUSIONS The BIOVASC study aims to further refine the treatment algorithm for acute coronary syndrome patients with multivessel disease in terms of optimal timing for complete revascularization (Clinicaltrials.gov NCT03621501).
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10
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Bossard M, Mehta SR. Complete or Incomplete Revascularization for ST-Segment Elevation Myocardial Infarction: The PRAMI Trial to COMPLETE. Interv Cardiol Clin 2020; 9:433-440. [PMID: 32921367 DOI: 10.1016/j.iccl.2020.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Many patients presenting with ST-segment elevation myocardial infarction (STEMI) have multivessel coronary artery disease (CAD). Following successful primary percutaneous coronary intervention (PCI) of culprit lesion, whether to routinely revascularize nonculprit lesions or treat them medically has been debated. Recently, the large-scale, multinational COMPLETE trial definitively established benefit of routine, staged, angiographically guided nonculprit lesion PCI in reducing hard clinical outcomes, including the composite of death from cardiovascular causes or new myocardial infarction, with no major safety concerns. A strategy of complete revascularization with routine nonculprit lesion PCI in suitable lesions should be standard of care in STEMI with multivessel CAD.
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Affiliation(s)
- Matthias Bossard
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Spitalstrasse 16, Luzern 6000, Switzerland
| | - Shamir R Mehta
- Population Health Research Institute, McMaster University, Hamilton General Hospital, Hamilton Health Sciences, 237 Barton Street East, Hamilton, Ontario L8L 2X2, Canada.
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11
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Ohashi J, Sakakura K, Sasaki W, Taniguchi Y, Kani K, Yamamoto K, Tsukui T, Seguchi M, Wada H, Momomura SI, Fujita H. Usefulness of 500-m walk electrocardiogram test on clinical outcomes in patients with ST-segment elevation myocardial infarction. Heart Vessels 2020; 36:48-57. [PMID: 32671463 DOI: 10.1007/s00380-020-01667-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 07/10/2020] [Indexed: 10/23/2022]
Abstract
The current Japanese guideline for ST-segment elevation myocardial infarction (STEMI) recommends 500-m walk electrocardiogram (ECG) test for patients with STEMI during hospitalization. However, little is known regarding the association between acute phase 500-m walk ECG test and clinical outcomes. The purpose of this study was to investigate the association between 500-m walk ECG test and mid-term clinical outcomes in patients with STEMI. A total of 313 STEMI patients who underwent primary percutaneous coronary interventions were included, and were divided into the successful 500-m group (n = 263) and the unsuccessful 500-m group (n = 50). The primary endpoint was the major adverse cardiovascular events (MACE), which were defined as the composite of all cause death, acute myocardial infarction, readmission for heart failure, and ischemia-driven target vessel revascularization (TVR). During the follow-up period (median 223 days), a total of 55 MACE were observed. The log-rank test revealed that MACE, all cause death, readmission for heart failure, and ischemia-driven TVR were more frequently observed in the unsuccessful 500-m group than the successful 500-m group. In the multivariate Cox proportional hazard model, the unsuccessful 500-m walk ECG test was significantly associated with MACE (OR 5.62, 95% CI 3.08-10.08, P < 0.01) after controlling confounding factors such as age, and serum creatinine levels. In conclusion, the unsuccessful 500-m walk ECG test was significantly associated with poor mid-term outcomes in patients with STEMI. Our results suggest the usefulness of 500-m walk ECG test to stratify the high-risk group from patients with STEMI.
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Affiliation(s)
- Jumpei Ohashi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Omiya-ku, Amanuma, Saitama, 330-8503, Japan
| | - Kenichi Sakakura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Omiya-ku, Amanuma, Saitama, 330-8503, Japan.
| | - Wataru Sasaki
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Omiya-ku, Amanuma, Saitama, 330-8503, Japan
| | - Yousuke Taniguchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Omiya-ku, Amanuma, Saitama, 330-8503, Japan
| | - Kunihiro Kani
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Omiya-ku, Amanuma, Saitama, 330-8503, Japan
| | - Kei Yamamoto
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Omiya-ku, Amanuma, Saitama, 330-8503, Japan
| | - Takunori Tsukui
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Omiya-ku, Amanuma, Saitama, 330-8503, Japan
| | - Masaru Seguchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Omiya-ku, Amanuma, Saitama, 330-8503, Japan
| | - Hiroshi Wada
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Omiya-ku, Amanuma, Saitama, 330-8503, Japan
| | - Shin-Ichi Momomura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Omiya-ku, Amanuma, Saitama, 330-8503, Japan
| | - Hideo Fujita
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Omiya-ku, Amanuma, Saitama, 330-8503, Japan
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Tovar Forero MN, Scarparo P, den Dekker W, Balbi M, Masdjedi K, van Zandvoort L, Kardys I, Ameloot K, Daemen J, Lemmert M, Wilschut J, de Jaegere P, Zijlstra F, Van Mieghem N, Diletti R. Revascularization Strategies in Patients Presenting With ST-Elevation Myocardial Infarction and Multivessel Coronary Disease. Am J Cardiol 2020; 125:1486-1491. [PMID: 32200948 DOI: 10.1016/j.amjcard.2020.01.050] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 01/26/2020] [Accepted: 01/30/2020] [Indexed: 11/28/2022]
Abstract
The optimal revascularization strategy for residual coronary stenosis following primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease (MVD) remains controversial. This is a retrospective single-centre study including patients with STEMI and MVD. Based on the revascularization strategy, 3 groups were identified: (1) culprit only (CO), (2) ad hoc multivessel revascularization (MVR), and (3) staged MVR. Clinical outcomes were compared in terms of major adverse cardiac events (MACE), a composite of cardiac death, any myocardial infarction, and any unplanned revascularization at a long-term follow-up. A total of 958 patients were evaluated, 489 in the CO, 254 in the ad hoc, and 215 in the staged group. In the staged group, 65.6% of the patients received planned percutaneous coronary intervention, 9.7% coronary artery bypass grafting, 8.4% no further intervention after lesion reassessment, and in 16.3% an event occurred before the planned procedure. At 1,095 days, MACE was 36.1%, 16.7%, and 31% for CO, ad hoc, and staged groups, respectively. A MVR strategy was associated with lower rate of all-cause death compared with CO (HR 0.50; 95%CI [0.31 to 0.80]; p = 0.004). Complete revascularization reduced the rate of MACE (HR 0.30 [0.21 to 0.43] p < 0.001) compared with incomplete revascularization. Ad hoc MVR had lower rate of MACE compared with staged MVR (HR 0.61 [0.39 to 0.96] p = 0.032) mainly driven by less unplanned revascularizations. In conclusion, in patients with STEMI and MVD, complete revascularization reduced the risk of MACE. Ad hoc MVR appeared a reasonable strategy with lower contrast and stent usage and costs.
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Affiliation(s)
| | - Paola Scarparo
- Department of Cardiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Wijnand den Dekker
- Department of Cardiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Matthew Balbi
- Department of Cardiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Kaneshka Masdjedi
- Department of Cardiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Laurens van Zandvoort
- Department of Cardiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Isabella Kardys
- Department of Cardiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Koen Ameloot
- Department of Cardiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Joost Daemen
- Department of Cardiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Miguel Lemmert
- Department of Cardiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Jeroen Wilschut
- Department of Cardiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Peter de Jaegere
- Department of Cardiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Felix Zijlstra
- Department of Cardiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Nicolas Van Mieghem
- Department of Cardiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Roberto Diletti
- Department of Cardiology, Erasmus University Medical Centre, Rotterdam, The Netherlands.
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Hu PT, Jones WS, Glorioso TJ, Barón AE, Grunwald GK, Waldo SW, Maddox TM, Vidovich M, Banerjee S, Rao SV. Predictors and Outcomes of Staged Versus One-Time Multivessel Revascularization in Multivessel Coronary Artery Disease: Insights From the VA CART Program. JACC Cardiovasc Interv 2019; 11:2265-2273. [PMID: 30466824 DOI: 10.1016/j.jcin.2018.07.055] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 07/24/2018] [Accepted: 07/31/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVES The aim of this study was to determine predictors and outcomes associated with staged percutaneous coronary intervention (PCI) versus one-time multivessel revascularization (OTMVR) in patients with multivessel coronary artery disease. BACKGROUND Prior observational studies have not evaluated predictors and outcomes of staged PCI versus OTMVR in a heterogenous population of patients with multivessel coronary artery disease who undergo multivessel revascularization. METHODS Data from the Veterans Affairs (VA) CART (Clinical Assessment, Reporting, and Tracking) Program were used to evaluate patients who underwent PCI of >2 vessels between October 1, 2007, and September 3, 2014. Associations between individual factors and the decision to perform staged PCI were assessed. Additionally, the impact of measured patient and procedural factors, site factors, and unmeasured site factors on the decision to perform staged PCI was compared. Cox proportional hazards models were used to determine the association between staged PCI and mortality. RESULTS A total of 7,599 patients at 61 sites were included. The decision to perform staged PCI was driven by procedural characteristics and unmeasured site factors. Staged PCI was associated with lower risk-adjusted mortality compared with OTMVR (adjusted hazard ratio [HR]: 0.78; 95% confidence interval [CI]: 0.72 to 0.84; p < 0.01). This mortality benefit was observed among the ST-segment elevation myocardial infarction (HR: 0.31; 95% CI: 0.21 to 0.47; p < 0.01), non-ST-segment elevation myocardial infarction (HR: 0.74; 95% CI: 0.64 to 0.87; p < 0.01), unstable angina (HR: 0.75; 95% CI: 0.64 to 0.89; p < 0.01) and stable angina (HR: 0.88; 95% CI: 0.77 to 1.00; p = 0.05) groups. CONCLUSIONS The decision to pursue staged PCI was driven by procedural characteristics and unmeasured site variation and was associated with lower mortality compared with OTMVR. After adjustment, there was an association between staged PCI and reduced mortality. Given the observational nature of these findings, a randomized trial comparing the 2 is needed to guide practice.
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Affiliation(s)
- Peter T Hu
- Department of Cardiology, Cleveland Clinic, Cleveland, Ohio; Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - W Schuyler Jones
- Department of Medicine, Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
| | - Thomas J Glorioso
- Denver Veterans Affairs Medical Center, Denver, Colorado; Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Anna E Barón
- Denver Veterans Affairs Medical Center, Denver, Colorado; Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Gary K Grunwald
- Denver Veterans Affairs Medical Center, Denver, Colorado; Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Stephen W Waldo
- Denver Veterans Affairs Medical Center, Denver, Colorado; Section of Cardiology, University of Colorado School of Medicine, Aurora, Colorado
| | - Thomas M Maddox
- Division of Cardiology, Washington University, St. Louis, Missouri
| | - Mladen Vidovich
- University of Illinois College of Medicine, Chicago, Illinois; Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois
| | - Subhash Banerjee
- University of Texas Southwestern Medical Center, Dallas, Texas; Veterans Affairs North Texas Health Care System, Dallas, Texas
| | - Sunil V Rao
- Department of Medicine, Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina; Durham Veterans Affairs Medical Center, Durham, North Carolina.
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Xu H, Zhang X, Li J, Liu H, Hu X, Yang J. Complete versus culprit-only revascularization in patients with ST-segment elevation myocardial infarction and multivessel disease: a meta-analysis of randomized trials. BMC Cardiovasc Disord 2019; 19:91. [PMID: 31010423 PMCID: PMC6477715 DOI: 10.1186/s12872-019-1073-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 04/09/2019] [Indexed: 12/30/2022] Open
Abstract
Background The best strategy for the treatment of the non-infarct artery in patients with ST-elevation myocardial infarction (STEMI) and multivessel disease (MVD) undergoing primary percutaneous coronary intervention (PCI) is not yet defined. Methods We searched the literature for randomized controlled trials (RCTs) that compared complete revascularization (CR) with infarct-related coronary artery (IRA) only revascularization in hemodynamically stable patients with STEMI. Random effect risk ratios (RRs) were calculated for clinical outcomes. Results Nine RCTs with 2989 patients were included. No significant difference in all-cause mortality emerged between CR and IRA-only groups (relative risk [RR] = 0.74; 95% confidence interval [CI]: 0.52 to 1.04; p = 0.08). Compared with IRA-only, CR was associated with significantly lower rates of major adverse cardiac events (MACE) (RR = 0.53; 95% CI: 0.41 to 0.68; p < 0.001), cardiac death (RR = 0.48; 95% CI: 0.29 to 0.79; p = 0.004) and repeat revascularization (RR = 0.38; 95% CI: 0.30 to 0.47; p < 0.001). In subgroups analysis, immediate complete revascularization (ICR) reduced the risk of all-cause mortality (RR = 0.62; 95% CI: 0.39 to 0.97; p = 0.04), whereas staged complete revascularization (SCR) did not show any significant benefit in all-cause mortality (RR = 0.92; 95% CI: 0.46 to 1.86; p = 0.82). Stroke, contrast-induced nephropathy and major bleeding were not different between CR and IRA-only. Conclusions For patients with STEMI and multivessel disease undergoing primary PCI, complete revascularization did not decrease the risk of all-cause mortality in current evidence from randomized trials. When feasible, immediate complete revascularization might be considered in patients with STEMI and multivessel disease. Electronic supplementary material The online version of this article (10.1186/s12872-019-1073-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Haiyan Xu
- Department of Cardiology, The affiliated Huaian No.1 People's Hospital of Nanjing Medical University, 6 Beijing Road West, Huai'an, 223300, Jiangsu, China
| | - Xiwen Zhang
- Department of Cardiology, The affiliated Huaian No.1 People's Hospital of Nanjing Medical University, 6 Beijing Road West, Huai'an, 223300, Jiangsu, China
| | - Jiangjin Li
- Department of Cardiology, The affiliated Huaian No.1 People's Hospital of Nanjing Medical University, 6 Beijing Road West, Huai'an, 223300, Jiangsu, China
| | - Hailang Liu
- Department of Cardiology, The affiliated Huaian No.1 People's Hospital of Nanjing Medical University, 6 Beijing Road West, Huai'an, 223300, Jiangsu, China
| | - Xiao Hu
- Department of Cardiology, The affiliated Huaian No.1 People's Hospital of Nanjing Medical University, 6 Beijing Road West, Huai'an, 223300, Jiangsu, China
| | - Jing Yang
- Department of Cardiology, The affiliated Huaian No.1 People's Hospital of Nanjing Medical University, 6 Beijing Road West, Huai'an, 223300, Jiangsu, China.
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15
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Angiography-guided Multivessel Percutaneous Coronary Intervention Versus Ischemia-guided Percutaneous Coronary Intervention Versus Medical Therapy in the Management of Significant Disease in Non-Infarct-related Arteries in ST-Elevation Myocardial Infarction Patients With Multivessel Coronary Disease. Crit Pathw Cardiol 2019; 17:77-82. [PMID: 29768315 DOI: 10.1097/hpc.0000000000000144] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND In ST-elevation myocardial infarction (STEMI) patients with multivessel (MV) disease, after primary percutaneous coronary intervention (PCI), emerging evidence suggests that significant disease in non-infarct-related coronary arteries (IRAs) should be routinely stented. Whether this procedure should be guided by angiography alone or ischemia testing is unclear. METHODS All STEMI patients treated with primary PCI between January 1, 2005, and December 31, 2012, at a tertiary cardiology center were reviewed retrospectively. Inclusion criterion is patients with at least 70% stenosis in non-IRAs. There were 3 treatment groups: (1) angiography-guided MV-PCI, (2) ischemia-guided PCI, and (3) medical therapy. Primary endpoint is all-cause mortality, and secondary end point is major adverse cardiovascular events (MACE), including death, acute coronary syndrome, revascularization, or stent thrombosis. Event-free survivals were compared using multivariate Cox proportional-hazards analysis. A propensity score-adjusted analysis was performed. RESULTS Four hundred forty-seven STEMI patients had >70% stenosis in non-IRAs. For all-cause mortality, the 3 strategies did not differ. For MACE, ischemia-guided PCI was associated with the lowest MACE rate, followed by angiography-guided PCI and medical therapy, which was associated with the highest MACE rate, driven by death and myocardial infarction. Hazard ratios (HRs) for MACE: angiography-guided MV-PCI versus ischemia-guided MV-PCI: HR = 2.23 [95% confidence interval (CI), 1.11-4.48; P = 0.023]; medical therapy versus angiography-guided MV-PCI: HR = 1.58 (95% CI, 0.99-2.63; P = 0.062); medical therapy versus ischemia-guided MV-PCI: HR = 1.72 (95% CI, 1.08-2.74; P = 0.022). Propensity score-adjusted analysis yielded similar results. CONCLUSIONS After primary PCI, complete revascularization in STEMI multivessel disease is associated with lower MACE rates than medical therapy. However, ischemia-testing-guided rather than angiography-guided revascularization was associated with the lowest MACE. This study provides preliminary data and hypotheses for future randomized controlled studies.
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16
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McCutcheon K, Triantafyllis AS, Marynissen T, Adriaenssens T, Bennett J, Dubois C, Sinnaeve PR, Desmet W. Major adverse cardiovascular events while awaiting staged non-culprit percutaneous coronary intervention after ST-segment elevation myocardial infarction. Acta Cardiol 2019; 74:60-64. [PMID: 29560788 DOI: 10.1080/00015385.2018.1453959] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND The optimal therapeutic strategy for ST-segment elevation myocardial infarction (STEMI) patients found to have multi-vessel disease (MVD) is controversial but recent data support complete revascularisation (CR). Whether CR should be completed during the index admission or during a second staged admission remains unclear. Our main objective was to measure rates of major adverse cardiovascular events (MACEs) during the waiting period in STEMI patients selected for staged revascularisation (SR), in order to determine the safety of delaying CR. For completeness, we also describe 30-day and long-term outcomes in STEMI patients with MVD who underwent in-hospital CR. METHODS A single-centre retrospective analysis of 931 STEMI patients treated by primary percutaneous coronary intervention (PCI) identified 397 patients with MVD who were haemodynamically stable and presented within 12 hours of chest pain onset. Of these, 191 underwent multi-vessel PCI: 49 during the index admission and 142 patients undergoing a strategy of SR. RESULTS Our main finding was that waiting period MACE were 2% (three of 142) in patients allocated to SR (at a median of 31 days). In patients allocated to in-hospital CR, 30-day MACE rates were 10% (five of 49). During a median follow up of 39 months, all-cause mortality was 7.0% vs. 28.6%, and cardiac mortality was 2% vs. 8%, in patients allocated to SR or CR, respectively. CONCLUSIONS Patients with STEMI and MVD who, based on clinical judgement, were allocated to a second admission SR strategy had very few adverse events during the waiting period and excellent long-term outcomes.
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Affiliation(s)
- Keir McCutcheon
- Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven, Belgium
| | | | - Thomas Marynissen
- Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Tom Adriaenssens
- Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven, Belgium
- Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Johan Bennett
- Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Christophe Dubois
- Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven, Belgium
- Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Peter R. Sinnaeve
- Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven, Belgium
- Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Walter Desmet
- Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven, Belgium
- Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
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17
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Phillips LM, Vitola JV, Shaw LJ, Giubbini R, Karthikeyan G, Alexanderson E, Dondi M, Paez D, Peix A. Value of gated-SPECT MPI for ischemia-guided PCI of non-culprit vessels in STEMI patients with multivessel disease after primary PCI. J Nucl Cardiol 2018; 25:1616-1620. [PMID: 30069820 DOI: 10.1007/s12350-018-1368-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 05/31/2018] [Indexed: 02/08/2023]
Abstract
There remains a clinical question of which patients benefit from revascularization of non-culprit coronary artery stenosis in the setting of acute ST-segment elevation myocardial infraction (STEMI). This is a large population of patients with prior studies showing 40 to 70% of patients with STEMI having non-culprit stenosis. This article reviews the current state of the literature evaluating outcomes of those previously randomized to revascularization of non-culprit stenosis around the time of the STEMI. We propose a new study design to utilize gated-SPECT in the decision process by using an ischemic burden of > 5% as a cut-off for revascularization vs. complete revascularization without ischemia assessment.
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Affiliation(s)
- Lawrence M Phillips
- Division of Cardiology, Department of Medicine, New York University Langone Health, New York, NY, USA.
| | | | - Leslee J Shaw
- Division of Cardiology Department of Medicine, Emory University, Atlanta, Georgia
| | | | | | - Erick Alexanderson
- Depto. Fisiologia, Facultad de Medicina, UNAM and Instituto Nacional de Cardiología, Mexico City, Mexico
| | - Maurizio Dondi
- International Atomic Energy Agency, Nuclear Medicine and Diagnostic Imaging Section, Vienna, Austria
| | - Diana Paez
- International Atomic Energy Agency, Nuclear Medicine and Diagnostic Imaging Section, Vienna, Austria
| | - Amalia Peix
- Department of Nuclear Medicine, Institute of Cardiology, La Habana, Cuba
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18
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Complete Versus Culprit-Only Revascularization in STEMI: a Contemporary Review. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2018; 20:41. [PMID: 29627944 DOI: 10.1007/s11936-018-0636-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
PURPOSE OF REVIEW In ST-segment elevation myocardial infarction, urgent revascularization of the culprit coronary vessel and restoration of coronary flow is the goal of the initial management. However, obstructive non-culprit disease is frequently concomitantly found during initial angiography and portends a poor prognosis. Management of non-culprit lesions in ST-segment elevation myocardial infarction (STEMI) has been the subject of extensive debate. This review will examine the currently available evidence, with a specific focus on randomized clinical trials performed to date. RECENT FINDINGS Although early observational data suggested better outcomes with culprit-only revascularization, more recent data from several randomized trials have suggested improved outcomes with complete multivessel revascularization, either during the index PCI procedure or as a staged procedure. Data from recent randomized controlled trials have suggested the superiority of complete or multivessel revascularization and have subsequently led to changes to the most recent iterations of STEMI guidelines. However, the optimal management and timing of revascularization of non-culprit lesions in STEMI remain controversial.
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de La Torre Hernandez JM, Gomez Hospital JA, Baz JA, Brugaletta S, Perez de Prado A, Linares JA, Lopez Palop R, Cid B, Garcia Camarero T, Diego A, Gutierrez H, Fernandez Diaz JA, Sanchis J, Alfonso F, Blanco R, Botas J, Navarro Cuartero J, Moreu J, Bosa F, Vegas JM, Elizaga J, Arrebola AL, Hernandez F, Salvatella N, Monteagudo M, Gomez Jaume A, Carrillo X, Martin Reyes R, Lozano F, Rumoroso JR, Andraka L, Dominguez AJ. Multivessel disease in patients over 75years old with ST elevated myocardial infarction. Current management strategies and related clinical outcomes in the ESTROFA MI+75 nation-wide registry. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2018; 19:580-588. [PMID: 29306670 DOI: 10.1016/j.carrev.2017.12.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 12/03/2017] [Accepted: 12/05/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND In elderly patients with ST elevated myocardial infarction (STEMI) and multivessel disease (MVD the outcomes related with different revascularization strategies are not well known. METHODS Subgroup-analysis of a nation-wide registry of primary angioplasty in the elderly (ESTROFA MI+75) with 3576 patients over 75years old from 31 centers. Patients with MVD were analyzed to describe treatment approaches and 2years outcomes. RESULTS Of 1830 (51%) with MVD, 847 (46%) underwent multivessel revascularization either in acute (51%), staged (44%) or both procedures (5%). Patients with previous myocardial infarction and those receiving drug-eluting stents or IIb-IIIa inhibitors were more prone to be revascularized, whereas older patients, females and those with Killip III-IV, renal failure and higher ejection fraction were less likely. Survival free of cardiac death and infarction at 2years was better for those undergoing multivessel PCI (85.8% vs. 80.4%, p<0.0008), regardless of Killip class. Multivessel PCI was protective of cardiac death and infarction (HR 0.60, 95% CI 0.40-0.89; p=0.011). Complete revascularization made no difference in outcomes among those patients undergoing multivessel PCI. The best prognosis corresponded to those undergoing multivessel PCI in staged procedures (p<0.001). A propensity score matching analysis (514 patients in each group) yielded similar results. CONCLUSIONS In elderly patients with STEMI and MVD, multivessel PCI was related with better outcomes especially after staged procedures. Among those undergoing multivessel PCI, anatomically defined completeness of revascularization had not prognostic influence. SUMMARY We sought to investigate the revascularization strategies applied and their prognostic implications in patients aged over 75years with ST elevated myocardial infarction showing multivessel disease. Of 1830 patients, 847 (46%) underwent multivessel PCI either in acute (51%), staged (44%) or both procedures (5%). Multivessel PCI was independent predictor of cardiac death and infarction with the best prognosis corresponding to those undergoing staged procedures.
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Affiliation(s)
| | | | - Jose A Baz
- Hospital de Vigo, Servicio de Cardiologia, Vigo, Spain
| | | | | | - Jose A Linares
- Hospital Clinico de Zaragoza, Servicio de Cardiologia, Zaragoza, Spain
| | | | - Belen Cid
- Hospital de Santiago de Compostela, Servicio de Cardiologia, Santiago de Compostela, Spain
| | | | - Alejandro Diego
- Hospital Clinico de Salamanca, Servicio de Cardiologia, Salamanca, Spain
| | - Hipolito Gutierrez
- Hospital Clinico de Valladolid, Servicio de Cardiologia, Valladolid, Spain
| | | | - Juan Sanchis
- Hospital Clinico de Valencia, Servicio de Cardiologia, Valencia, Spain
| | | | - Roberto Blanco
- Hospital de Cruces, Bilbao, Servicio de Cardiologia, Spain
| | - Javier Botas
- Hospital de Alcorcon, Servicio de Cardiologia, Alcorcon, Spain
| | | | - Jose Moreu
- Hospital Virgen de la Salud, Servicio de Cardiologia, Toledo, Spain
| | - Francisco Bosa
- Hospital Clinico de Tenerife, Servicio de Cardiologia, Santa Cruz de Tenerife, Spain
| | - Jose M Vegas
- Hospital de Cabueñes, Servicio de Cardiologia, Gijon, Spain
| | - Jaime Elizaga
- Hospital Gregorio Marañon, Servicio de Cardiologia, Madrid, Spain
| | | | | | - Neus Salvatella
- Hospital del Mar, Servicio de Cardiología, Grup de Recerca Biomèdica en Malalties del Cor, IMIM (Hospital del Mar Reseach Institute), Barcelona, Spain
| | | | | | - Xavier Carrillo
- Hospital Germans Trias i Pujol, Servicio de Cardiologia, Badalona, Spain
| | | | - Fernando Lozano
- Hospital de Ciudad Real, Servicio de Cardiologia, Ciudad Real, Spain
| | - Jose R Rumoroso
- Hospital de Galdacano, Servicio de Cardiologia, Bilbao, Spain
| | - Leire Andraka
- Hospital de Basurto, Servicio de Cardiologia, Bilbao, Spain
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20
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Vogel B, Mehta SR, Mehran R. Reperfusion strategies in acute myocardial infarction and multivessel disease. Nat Rev Cardiol 2017; 14:665-678. [DOI: 10.1038/nrcardio.2017.88] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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21
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Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, Chambers CE, Ellis SG, Guyton RA, Hollenberg SM, Khot UN, Lange RA, Mauri L, Mehran R, Moussa ID, Mukherjee D, Ting HH, O'Gara PT, Kushner FG, Ascheim DD, Brindis RG, Casey DE, Chung MK, de Lemos JA, Diercks DB, Fang JC, Franklin BA, Granger CB, Krumholz HM, Linderbaum JA, Morrow DA, Kristin Newby L, Ornato JP, Ou N, Radford MJ, Tamis-Holland JE, Tommaso CL, Tracy CM, Joseph Woo Y, Zhao DX, Halperin JL, Levine GN, Anderson JL, Albert NM, Al-Khatib SM, Birtcher KK, Bozkurt B, Brindis RG, Cigarroa JE, Curtis LH, Fleisher LA, Gentile F, Gidding S, Hlatky MA, Ikonomidis J, Joglar J, Kovacs RJ, Magnus Ohman E, Pressler SJ, Sellke FW, Shen WK, Wijeysundera DN. 2015 ACC/AHA/SCAI focused update on primary percutaneous coronary intervention for patients with ST-elevation myocardial Infarction: An update of the 2011 ACCF/AHA/SCAI guideline for percutaneous coronary intervention and the 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. Catheter Cardiovasc Interv 2017; 87:1001-19. [PMID: 26489034 DOI: 10.1002/ccd.26325] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
| | | | | | - Eric R Bates
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendixes 1 and 2 for detailed information.,ACC/AHA Representative
| | - James C Blankenship
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendixes 1 and 2 for detailed information.,SCAI Representative
| | - Steven R Bailey
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendixes 1 and 2 for detailed information.,SCAI Representative
| | | | | | | | - Stephen G Ellis
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendixes 1 and 2 for detailed information.,ACC/AHA Representative
| | | | - Steven M Hollenberg
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendixes 1 and 2 for detailed information.,ACC/AHA Representative
| | - Umesh N Khot
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendixes 1 and 2 for detailed information.,ACC/AHA Representative
| | | | - Laura Mauri
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendixes 1 and 2 for detailed information.,ACC/AHA Representative
| | - Roxana Mehran
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendixes 1 and 2 for detailed information.,SCAI Representative
| | | | | | | | | | | | | | - Deborah D Ascheim
- Dr. Deborah D. Ascheim accepted a position at Capricor Therapeutics in August 2015, after the writing effort was completed. In accordance with ACC/AHA policy, she recused herself from the final voting process
| | | | | | - Mina K Chung
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendixes 1 and 2 for detailed information.,ACC/AHA Representative
| | - James A de Lemos
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendixes 1 and 2 for detailed information.,ACC/AHA Representative
| | | | - James C Fang
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendixes 1 and 2 for detailed information.,ACC/AHA Representative
| | | | - Christopher B Granger
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendixes 1 and 2 for detailed information.,ACC/AHA Representative
| | - Harlan M Krumholz
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendixes 1 and 2 for detailed information.,ACC/AHA Representative
| | | | - David A Morrow
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendixes 1 and 2 for detailed information.,ACC/AHA Representative
| | - L Kristin Newby
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendixes 1 and 2 for detailed information.,ACC/AHA Representative
| | - Joseph P Ornato
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendixes 1 and 2 for detailed information.,ACC/AHA Representative
| | | | | | | | | | | | | | - David X Zhao
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendixes 1 and 2 for detailed information.,ACC/AHA Representative
| | | | | | | | | | - Nancy M Albert
- Former Task Force member; current member during the writing effort
| | | | | | | | | | | | | | | | | | | | | | | | | | - Richard J Kovacs
- Former Task Force member; current member during the writing effort
| | - E Magnus Ohman
- Former Task Force member; current member during the writing effort
| | | | - Frank W Sellke
- Former Task Force member; current member during the writing effort
| | - Win-Kuang Shen
- Former Task Force member; current member during the writing effort
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22
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Qiu M, Li Y, Li J, Xu K, Jing Q, Dong S, Jin Z, Zhao P, Xu B, Han Y. Impact of six versus 12 months of dual antiplatelet therapy in patients with drug-eluting stent implantation after risk stratification with the residual SYNTAX score: Results from a secondary analysis of the I-LOVE-IT 2 trial. Catheter Cardiovasc Interv 2017; 89:565-573. [PMID: 28211603 DOI: 10.1002/ccd.26948] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Accepted: 12/26/2016] [Indexed: 11/07/2022]
Affiliation(s)
- Miaohan Qiu
- The Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, China
- The Graduate School of Dalian Medical University, Dalian, China
| | - Yi Li
- The Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, China
| | - Jing Li
- The Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, China
| | - Kai Xu
- The Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, China
| | - Quanmin Jing
- The Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, China
| | - Shaohong Dong
- The Department of Cardiology, Shenzhen People's Hospital, Shenzhen, China
| | - Zhe Jin
- The Department of Cardiology, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Pitian Zhao
- The Department of Cardiology, Yidu Central Hospital of Weifang City, China
| | - Bo Xu
- The Catheterization Laboratory, Fu Wai Hospital, Beijing, China
| | - Yaling Han
- The Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, China
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23
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Marino M, Crimi G, Leonardi S, Ferlini M, Repetto A, Camporotondo R, Demarchi A, De Pascali I, Falcinella F, Oltrona Visconti L, De Servi S, Ferrario M, De Ferrari GM, Gnecchi M. Comparison of Outcomes of Staged Complete Revascularization Versus Culprit Lesion-Only Revascularization for ST-Elevation Myocardial Infarction and Multivessel Coronary Artery Disease. Am J Cardiol 2017; 119:508-514. [PMID: 28007297 DOI: 10.1016/j.amjcard.2016.10.040] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Revised: 10/31/2016] [Accepted: 10/31/2016] [Indexed: 01/03/2023]
Abstract
The management of noninfarct-related arteries in patients with ST-elevation myocardial infarction (STEMI) and multivessel coronary disease (MVD) is still debated. We evaluated the prognostic impact of staged complete revascularization with percutaneous coronary intervention (PCI) in STEMI patients with MVD admitted to our hospital from 2005 to 2013. Patients undergoing staged complete revascularization (n = 300) were compared with 1:1 propensity score-matched patients with culprit lesion-only treatment (n = 300). We considered a composite primary end point of all-cause death, myocardial infarction, and urgent PCI. Secondary end points included components of the primary, cardiovascular death, any PCI excluding staged PCI. We also performed an analysis including only patients surviving at least 5 days. The median follow-up was 553 days. The primary end point occurred in 10.3% of patients in the staged complete revascularization group and in 16.3% of patients in the culprit lesion-only group (hazard ratio 0.61, 95% CI 0.38 to 0.95, p = 0.031). Although this difference was no longer significant when considering only the survivors at day 5, all-cause and cardiovascular mortalities were still reduced in the staged complete revascularization group. Complete revascularization was associated with a better outcome (hazard ratio 0.35, 95% CI 0.17 to 0.63, p = 0.005) if performed within 30 days of STEMI. In conclusion, compared with culprit lesion-only revascularization, in STEMI patients with MVD undergoing primary PCI, an approach of staged complete revascularization was associated with a better outcome.
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24
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Yu T, Dong Y, Zhu J, Tian C, Sun Z, Sun Z. Culprit-only versus staged complete revascularization for patients with ST-segment elevation myocardial infarction and Multivessel disease: a retrospective cohort study. BMC Cardiovasc Disord 2016; 16:189. [PMID: 27716075 PMCID: PMC5053086 DOI: 10.1186/s12872-016-0365-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Accepted: 09/28/2016] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Multivessel disease (MVD) is common in patients with ST-segment elevation myocardial infarction (STEMI), but optimal treatment management remains undetermined. METHODS In this retrospective cohort study, 602 consecutive STEMI patients with MVD were enrolled between January 1, 2010 and October 1, 2014. Three hundred and eighty-two patients underwent culprit-only revascularization and 220 underwent staged complete revascularization. Primary end points were a composite of cardiac mortality or nonfatal reinfarction. RESULTS The mean duration of follow-up was 35 months (12-71 months). Following multivariate analysis, staged complete revascularization was associated with a lower rate of the composite of cardiac mortality or nonfatal reinfarction [HR: 0.430, 95 % CI: 0.197-0.940, P = 0.034] and unplanned repeat revascularization [HR: 0.343, 95 % CI: 0.166-0.708, P = 0.004] compared with culprit-only revascularization. CONCLUSIONS Compared with culprit-only revascularization, staged complete revascularization significantly reduced the rate of the composite of cardiac mortality or nonfatal reinfarction, and the need for unplanned repeat revascularization.
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Affiliation(s)
- Tongtong Yu
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning People’s Republic of China
| | - Yuanyuan Dong
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning People’s Republic of China
| | - Jiahe Zhu
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning People’s Republic of China
| | - Chunyang Tian
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning People’s Republic of China
| | - Zhijun Sun
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning People’s Republic of China
| | - Zhaoqing Sun
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning People’s Republic of China
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25
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Bates ER, Tamis-Holland JE, Bittl JA, O’Gara PT, Levine GN. PCI Strategies in Patients With ST-Segment Elevation Myocardial Infarction and Multivessel Coronary Artery Disease. J Am Coll Cardiol 2016; 68:1066-81. [DOI: 10.1016/j.jacc.2016.05.086] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 04/19/2016] [Accepted: 05/10/2016] [Indexed: 12/19/2022]
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26
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Karim ME, Gustafson P, Petkau J, Tremlett H. Comparison of Statistical Approaches for Dealing With Immortal Time Bias in Drug Effectiveness Studies. Am J Epidemiol 2016; 184:325-35. [PMID: 27455963 DOI: 10.1093/aje/kwv445] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 12/16/2015] [Indexed: 11/12/2022] Open
Abstract
In time-to-event analyses of observational studies of drug effectiveness, incorrect handling of the period between cohort entry and first treatment exposure during follow-up may result in immortal time bias. This bias can be eliminated by acknowledging a change in treatment exposure status with time-dependent analyses, such as fitting a time-dependent Cox model. The prescription time-distribution matching (PTDM) method has been proposed as a simpler approach for controlling immortal time bias. Using simulation studies and theoretical quantification of bias, we compared the performance of the PTDM approach with that of the time-dependent Cox model in the presence of immortal time. Both assessments revealed that the PTDM approach did not adequately address immortal time bias. Based on our simulation results, another recently proposed observational data analysis technique, the sequential Cox approach, was found to be more useful than the PTDM approach (Cox: bias = -0.002, mean squared error = 0.025; PTDM: bias = -1.411, mean squared error = 2.011). We applied these approaches to investigate the association of β-interferon treatment with delaying disability progression in a multiple sclerosis cohort in British Columbia, Canada (Long-Term Benefits and Adverse Effects of Beta-Interferon for Multiple Sclerosis (BeAMS) Study, 1995-2008).
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27
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Abstract
Primary PCI of infarct-related arteries is the preferred reperfusion strategy in patients presenting with ST-segment elevation myocardial infarction (STEMI). Up to 40 % of such patients demonstrate evidence of multivessel, non-infarct-related artery coronary disease. Previous non-randomised observational studies and their associated meta-analyses have suggested that in such cases only the culprit infarct-related artery (IRA) lesion should be treated. However, recent randomised controlled trials have demonstrated improved clinical outcomes with lower major adverse cardiovascular events (MACE) rates when complete revascularisation is undertaken either at index primary percutaneous coronary intervention (PPCI) or during index admission. These trials suggest that current guidelines pertaining to treatment of non-infarct-related artery (N-IRA) lesions in STEMI patients with multivessel disease may need to be reconsidered depending on future trials. However, issues remain around timing of N-IRA intervention, the use of fractional flow reserve (FFR) or intravascular imaging to guide intervention in N-IRA lesions and the need to demonstrate reductions in hard clinical endpoints (death and MI) after complete revascularisation; these issues will need to be addressed through future trials. Clinicians must judge on the currently available data, whether it is still safer to leave important stenosis in N-IRA untreated.
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Affiliation(s)
- Amerjeet S. Banning
- />Department of Cardiovascular Sciences, University of Leicester Glenfield Hospital, Groby Road, Leicester, LE3 9QP UK
| | - Anthony H. Gershlick
- />Department of Cardiovascular Sciences, University of Leicester Glenfield Hospital, Groby Road, Leicester, LE3 9QP UK
- />Department of Cardiology, University Hospitals of Leicester NHS Trust Glenfield Hospital, Groby Road, Leicester, LE3 9QP UK
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28
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Di Pasquale G, Filippini E, Pavesi PC, Tortorici G, Casella G, Sangiorgio P. Complete versus culprit-only revascularization in ST-elevation myocardial infarction and multivessel disease. Intern Emerg Med 2016; 11:499-506. [PMID: 26951188 DOI: 10.1007/s11739-016-1419-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Accepted: 02/18/2016] [Indexed: 02/04/2023]
Abstract
In 30-60 % of patients presenting with ST-segment elevation myocardial infarction (STEMI), significant stenoses are present in one or more non-infarct-related arteries (IRA). This correlates with an increased risk of major adverse cardiac events (MACE). Current guidelines, do not recommend revascularization of non-culprit lesions unless complicated by cardiogenic shock or persistent ischemia after primary percutaneous coronary intervention (PCI). Prior observational and small randomized controlled trials (RCTs) have demonstrated conflicting results regarding the optimal revascularization strategy in STEMI patients with multivessel disease. Recently, randomized studies (PRAMI, CvLPRIT, and DANAMI 3-PRIMULTI) provide encouraging data that suggest potential benefit with complete revascularization in STEMI patients with obstructive non-culprit lesions. Differently, in the PRAGUE-13 trial there were no differences in MACE between complete revascularization and culprit-only PCI. Several meta-analyses were recently published including randomized and non-randomized clinical trials, showing different results depending on the included trials. In conclusion, the current available evidence from the randomized clinical trials, with a total sample size of only 2000 patients, is not robust enough to firmly recommend complete revascularization in STEMI patients. This uncertainty lends support to the continuation of the COMPLETE trial. This ongoing trial is anticipated to enroll 3900 patients with STEMI from across the world, and will be powered for the hard outcomes of death and myocardial infarction. Until the results of the COMPLETE trial are reported, physicians need to individualize care regarding the opportunity and the timing of the non-IRA PCI.
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Affiliation(s)
- Giuseppe Di Pasquale
- Division of Cardiology, Maggiore Hospital, Largo Nigrisoli 2, 40133, Bologna, Italy.
| | - Elisa Filippini
- Division of Cardiology, Maggiore Hospital, Largo Nigrisoli 2, 40133, Bologna, Italy
| | - Pier Camillo Pavesi
- Division of Cardiology, Maggiore Hospital, Largo Nigrisoli 2, 40133, Bologna, Italy
| | - Gianfranco Tortorici
- Division of Cardiology, Maggiore Hospital, Largo Nigrisoli 2, 40133, Bologna, Italy
| | - Gianni Casella
- Division of Cardiology, Maggiore Hospital, Largo Nigrisoli 2, 40133, Bologna, Italy
| | - Pietro Sangiorgio
- Division of Cardiology, Maggiore Hospital, Largo Nigrisoli 2, 40133, Bologna, Italy
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29
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Managing Multivessel Coronary Artery Disease in Patients With ST-Elevation Myocardial Infarction: A Comprehensive Review. Cardiol Rev 2016; 25:179-188. [PMID: 27124268 DOI: 10.1097/crd.0000000000000110] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Multivessel coronary artery disease (CAD) is found in up to 60% of the patients presenting with an ST-elevation myocardial infarction (STEMI) and worsens the prognosis proportional to the extent of CAD severity. However, the 2013 American College of Cardiology/American Heart Association STEMI guidelines, based on mostly observational data, had recommended against a routine noninfarct-related artery percutaneous coronary intervention (PCI). After these guidelines were published, a handful of randomized trials became available, and they suggested that PCI of significant lesions in a noninfarct-related artery at the time of primary PCI might result in improved patient outcomes. The incidence of major adverse cardiac events was significantly reduced by 55% at 1 year and 65% at 2 years in patients undergoing angiographically guided PCI of nonculprit vessels at the time of primary PCI, in 2 different randomized trials. Fractional flow reserve-guided PCI of nonculprit vessels in this setting has also been shown to reduce cardiac events by 44% at 1 year. Meta-analyses of both nonrandomized and randomized trials have also suggested that complete revascularization at the time of STEMI significantly improves outcomes, including long-term all-cause mortality. In view of the emerging data, a focused update on primary PCI was published in 2015 and suggested that PCI of noninfarct-related arteries might be considered in selected patients. This article is a comprehensive review of the literature on the treatment of multivessel CAD in patients with STEMI, which provides the reader a critical analysis of the available information to determine the best therapeutic approach.
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30
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Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, Chambers CE, Ellis SG, Guyton RA, Hollenberg SM, Khot UN, Lange RA, Mauri L, Mehran R, Moussa ID, Mukherjee D, Ting HH, O'Gara PT, Kushner FG, Ascheim DD, Brindis RG, Casey DE, Chung MK, de Lemos JA, Diercks DB, Fang JC, Franklin BA, Granger CB, Krumholz HM, Linderbaum JA, Morrow DA, Newby LK, Ornato JP, Ou N, Radford MJ, Tamis-Holland JE, Tommaso CL, Tracy CM, Woo YJ, Zhao DX. 2015 ACC/AHA/SCAI Focused Update on Primary Percutaneous Coronary Intervention for Patients With ST-Elevation Myocardial Infarction: An Update of the 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention and the 2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. Circulation 2015; 133:1135-47. [PMID: 26490017 DOI: 10.1161/cir.0000000000000336] [Citation(s) in RCA: 338] [Impact Index Per Article: 37.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Glenn N Levine
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendixes 1 and 2 for detailed information. ACC/AHA Representative. SCAI Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Dr. Deborah D. Ascheim accepted a position at Capricor Therapeutics in August 2015, after the writing effort was completed. In accordance with ACC/AHA policy, she recused herself from the final voting process. ACP Representative. ACEP Representative. Former Task Force member; current member during the writing effort
| | - Eric R Bates
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendixes 1 and 2 for detailed information. ACC/AHA Representative. SCAI Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Dr. Deborah D. Ascheim accepted a position at Capricor Therapeutics in August 2015, after the writing effort was completed. In accordance with ACC/AHA policy, she recused herself from the final voting process. ACP Representative. ACEP Representative. Former Task Force member; current member during the writing effort
| | - James C Blankenship
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendixes 1 and 2 for detailed information. ACC/AHA Representative. SCAI Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Dr. Deborah D. Ascheim accepted a position at Capricor Therapeutics in August 2015, after the writing effort was completed. In accordance with ACC/AHA policy, she recused herself from the final voting process. ACP Representative. ACEP Representative. Former Task Force member; current member during the writing effort
| | - Steven R Bailey
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendixes 1 and 2 for detailed information. ACC/AHA Representative. SCAI Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Dr. Deborah D. Ascheim accepted a position at Capricor Therapeutics in August 2015, after the writing effort was completed. In accordance with ACC/AHA policy, she recused herself from the final voting process. ACP Representative. ACEP Representative. Former Task Force member; current member during the writing effort
| | - John A Bittl
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendixes 1 and 2 for detailed information. ACC/AHA Representative. SCAI Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Dr. Deborah D. Ascheim accepted a position at Capricor Therapeutics in August 2015, after the writing effort was completed. In accordance with ACC/AHA policy, she recused herself from the final voting process. ACP Representative. ACEP Representative. Former Task Force member; current member during the writing effort
| | - Bojan Cercek
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendixes 1 and 2 for detailed information. ACC/AHA Representative. SCAI Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Dr. Deborah D. Ascheim accepted a position at Capricor Therapeutics in August 2015, after the writing effort was completed. In accordance with ACC/AHA policy, she recused herself from the final voting process. ACP Representative. ACEP Representative. Former Task Force member; current member during the writing effort
| | - Charles E Chambers
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendixes 1 and 2 for detailed information. ACC/AHA Representative. SCAI Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Dr. Deborah D. Ascheim accepted a position at Capricor Therapeutics in August 2015, after the writing effort was completed. In accordance with ACC/AHA policy, she recused herself from the final voting process. ACP Representative. ACEP Representative. Former Task Force member; current member during the writing effort
| | - Stephen G Ellis
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendixes 1 and 2 for detailed information. ACC/AHA Representative. SCAI Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Dr. Deborah D. Ascheim accepted a position at Capricor Therapeutics in August 2015, after the writing effort was completed. In accordance with ACC/AHA policy, she recused herself from the final voting process. ACP Representative. ACEP Representative. Former Task Force member; current member during the writing effort
| | - Robert A Guyton
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendixes 1 and 2 for detailed information. ACC/AHA Representative. SCAI Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Dr. Deborah D. Ascheim accepted a position at Capricor Therapeutics in August 2015, after the writing effort was completed. In accordance with ACC/AHA policy, she recused herself from the final voting process. ACP Representative. ACEP Representative. Former Task Force member; current member during the writing effort
| | - Steven M Hollenberg
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendixes 1 and 2 for detailed information. ACC/AHA Representative. SCAI Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Dr. Deborah D. Ascheim accepted a position at Capricor Therapeutics in August 2015, after the writing effort was completed. In accordance with ACC/AHA policy, she recused herself from the final voting process. ACP Representative. ACEP Representative. Former Task Force member; current member during the writing effort
| | - Umesh N Khot
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendixes 1 and 2 for detailed information. ACC/AHA Representative. SCAI Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Dr. Deborah D. Ascheim accepted a position at Capricor Therapeutics in August 2015, after the writing effort was completed. In accordance with ACC/AHA policy, she recused herself from the final voting process. ACP Representative. ACEP Representative. Former Task Force member; current member during the writing effort
| | - Richard A Lange
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendixes 1 and 2 for detailed information. ACC/AHA Representative. SCAI Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Dr. Deborah D. Ascheim accepted a position at Capricor Therapeutics in August 2015, after the writing effort was completed. In accordance with ACC/AHA policy, she recused herself from the final voting process. ACP Representative. ACEP Representative. Former Task Force member; current member during the writing effort
| | - Laura Mauri
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendixes 1 and 2 for detailed information. ACC/AHA Representative. SCAI Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Dr. Deborah D. Ascheim accepted a position at Capricor Therapeutics in August 2015, after the writing effort was completed. In accordance with ACC/AHA policy, she recused herself from the final voting process. ACP Representative. ACEP Representative. Former Task Force member; current member during the writing effort
| | - Roxana Mehran
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendixes 1 and 2 for detailed information. ACC/AHA Representative. SCAI Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Dr. Deborah D. Ascheim accepted a position at Capricor Therapeutics in August 2015, after the writing effort was completed. In accordance with ACC/AHA policy, she recused herself from the final voting process. ACP Representative. ACEP Representative. Former Task Force member; current member during the writing effort
| | - Issam D Moussa
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendixes 1 and 2 for detailed information. ACC/AHA Representative. SCAI Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Dr. Deborah D. Ascheim accepted a position at Capricor Therapeutics in August 2015, after the writing effort was completed. In accordance with ACC/AHA policy, she recused herself from the final voting process. ACP Representative. ACEP Representative. Former Task Force member; current member during the writing effort
| | - Debabrata Mukherjee
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendixes 1 and 2 for detailed information. ACC/AHA Representative. SCAI Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Dr. Deborah D. Ascheim accepted a position at Capricor Therapeutics in August 2015, after the writing effort was completed. In accordance with ACC/AHA policy, she recused herself from the final voting process. ACP Representative. ACEP Representative. Former Task Force member; current member during the writing effort
| | - Henry H Ting
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendixes 1 and 2 for detailed information. ACC/AHA Representative. SCAI Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Dr. Deborah D. Ascheim accepted a position at Capricor Therapeutics in August 2015, after the writing effort was completed. In accordance with ACC/AHA policy, she recused herself from the final voting process. ACP Representative. ACEP Representative. Former Task Force member; current member during the writing effort
| | - Patrick T O'Gara
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendixes 1 and 2 for detailed information. ACC/AHA Representative. SCAI Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Dr. Deborah D. Ascheim accepted a position at Capricor Therapeutics in August 2015, after the writing effort was completed. In accordance with ACC/AHA policy, she recused herself from the final voting process. ACP Representative. ACEP Representative. Former Task Force member; current member during the writing effort
| | - Frederick G Kushner
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendixes 1 and 2 for detailed information. ACC/AHA Representative. SCAI Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Dr. Deborah D. Ascheim accepted a position at Capricor Therapeutics in August 2015, after the writing effort was completed. In accordance with ACC/AHA policy, she recused herself from the final voting process. ACP Representative. ACEP Representative. Former Task Force member; current member during the writing effort
| | - Deborah D Ascheim
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendixes 1 and 2 for detailed information. ACC/AHA Representative. SCAI Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Dr. Deborah D. Ascheim accepted a position at Capricor Therapeutics in August 2015, after the writing effort was completed. In accordance with ACC/AHA policy, she recused herself from the final voting process. ACP Representative. ACEP Representative. Former Task Force member; current member during the writing effort
| | - Ralph G Brindis
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendixes 1 and 2 for detailed information. ACC/AHA Representative. SCAI Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Dr. Deborah D. Ascheim accepted a position at Capricor Therapeutics in August 2015, after the writing effort was completed. In accordance with ACC/AHA policy, she recused herself from the final voting process. ACP Representative. ACEP Representative. Former Task Force member; current member during the writing effort
| | - Donald E Casey
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendixes 1 and 2 for detailed information. ACC/AHA Representative. SCAI Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Dr. Deborah D. Ascheim accepted a position at Capricor Therapeutics in August 2015, after the writing effort was completed. In accordance with ACC/AHA policy, she recused herself from the final voting process. ACP Representative. ACEP Representative. Former Task Force member; current member during the writing effort
| | - Mina K Chung
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendixes 1 and 2 for detailed information. ACC/AHA Representative. SCAI Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Dr. Deborah D. Ascheim accepted a position at Capricor Therapeutics in August 2015, after the writing effort was completed. In accordance with ACC/AHA policy, she recused herself from the final voting process. ACP Representative. ACEP Representative. Former Task Force member; current member during the writing effort
| | - James A de Lemos
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendixes 1 and 2 for detailed information. ACC/AHA Representative. SCAI Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Dr. Deborah D. Ascheim accepted a position at Capricor Therapeutics in August 2015, after the writing effort was completed. In accordance with ACC/AHA policy, she recused herself from the final voting process. ACP Representative. ACEP Representative. Former Task Force member; current member during the writing effort
| | - Deborah B Diercks
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendixes 1 and 2 for detailed information. ACC/AHA Representative. SCAI Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Dr. Deborah D. Ascheim accepted a position at Capricor Therapeutics in August 2015, after the writing effort was completed. In accordance with ACC/AHA policy, she recused herself from the final voting process. ACP Representative. ACEP Representative. Former Task Force member; current member during the writing effort
| | - James C Fang
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendixes 1 and 2 for detailed information. ACC/AHA Representative. SCAI Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Dr. Deborah D. Ascheim accepted a position at Capricor Therapeutics in August 2015, after the writing effort was completed. In accordance with ACC/AHA policy, she recused herself from the final voting process. ACP Representative. ACEP Representative. Former Task Force member; current member during the writing effort
| | - Barry A Franklin
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendixes 1 and 2 for detailed information. ACC/AHA Representative. SCAI Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Dr. Deborah D. Ascheim accepted a position at Capricor Therapeutics in August 2015, after the writing effort was completed. In accordance with ACC/AHA policy, she recused herself from the final voting process. ACP Representative. ACEP Representative. Former Task Force member; current member during the writing effort
| | - Christopher B Granger
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendixes 1 and 2 for detailed information. ACC/AHA Representative. SCAI Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Dr. Deborah D. Ascheim accepted a position at Capricor Therapeutics in August 2015, after the writing effort was completed. In accordance with ACC/AHA policy, she recused herself from the final voting process. ACP Representative. ACEP Representative. Former Task Force member; current member during the writing effort
| | - Harlan M Krumholz
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendixes 1 and 2 for detailed information. ACC/AHA Representative. SCAI Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Dr. Deborah D. Ascheim accepted a position at Capricor Therapeutics in August 2015, after the writing effort was completed. In accordance with ACC/AHA policy, she recused herself from the final voting process. ACP Representative. ACEP Representative. Former Task Force member; current member during the writing effort
| | - Jane A Linderbaum
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendixes 1 and 2 for detailed information. ACC/AHA Representative. SCAI Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Dr. Deborah D. Ascheim accepted a position at Capricor Therapeutics in August 2015, after the writing effort was completed. In accordance with ACC/AHA policy, she recused herself from the final voting process. ACP Representative. ACEP Representative. Former Task Force member; current member during the writing effort
| | - David A Morrow
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendixes 1 and 2 for detailed information. ACC/AHA Representative. SCAI Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Dr. Deborah D. Ascheim accepted a position at Capricor Therapeutics in August 2015, after the writing effort was completed. In accordance with ACC/AHA policy, she recused herself from the final voting process. ACP Representative. ACEP Representative. Former Task Force member; current member during the writing effort
| | - L Kristin Newby
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendixes 1 and 2 for detailed information. ACC/AHA Representative. SCAI Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Dr. Deborah D. Ascheim accepted a position at Capricor Therapeutics in August 2015, after the writing effort was completed. In accordance with ACC/AHA policy, she recused herself from the final voting process. ACP Representative. ACEP Representative. Former Task Force member; current member during the writing effort
| | - Joseph P Ornato
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendixes 1 and 2 for detailed information. ACC/AHA Representative. SCAI Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Dr. Deborah D. Ascheim accepted a position at Capricor Therapeutics in August 2015, after the writing effort was completed. In accordance with ACC/AHA policy, she recused herself from the final voting process. ACP Representative. ACEP Representative. Former Task Force member; current member during the writing effort
| | - Narith Ou
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendixes 1 and 2 for detailed information. ACC/AHA Representative. SCAI Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Dr. Deborah D. Ascheim accepted a position at Capricor Therapeutics in August 2015, after the writing effort was completed. In accordance with ACC/AHA policy, she recused herself from the final voting process. ACP Representative. ACEP Representative. Former Task Force member; current member during the writing effort
| | - Martha J Radford
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendixes 1 and 2 for detailed information. ACC/AHA Representative. SCAI Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Dr. Deborah D. Ascheim accepted a position at Capricor Therapeutics in August 2015, after the writing effort was completed. In accordance with ACC/AHA policy, she recused herself from the final voting process. ACP Representative. ACEP Representative. Former Task Force member; current member during the writing effort
| | - Jacqueline E Tamis-Holland
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendixes 1 and 2 for detailed information. ACC/AHA Representative. SCAI Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Dr. Deborah D. Ascheim accepted a position at Capricor Therapeutics in August 2015, after the writing effort was completed. In accordance with ACC/AHA policy, she recused herself from the final voting process. ACP Representative. ACEP Representative. Former Task Force member; current member during the writing effort
| | - Carl L Tommaso
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendixes 1 and 2 for detailed information. ACC/AHA Representative. SCAI Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Dr. Deborah D. Ascheim accepted a position at Capricor Therapeutics in August 2015, after the writing effort was completed. In accordance with ACC/AHA policy, she recused herself from the final voting process. ACP Representative. ACEP Representative. Former Task Force member; current member during the writing effort
| | - Cynthia M Tracy
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendixes 1 and 2 for detailed information. ACC/AHA Representative. SCAI Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Dr. Deborah D. Ascheim accepted a position at Capricor Therapeutics in August 2015, after the writing effort was completed. In accordance with ACC/AHA policy, she recused herself from the final voting process. ACP Representative. ACEP Representative. Former Task Force member; current member during the writing effort
| | - Y Joseph Woo
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendixes 1 and 2 for detailed information. ACC/AHA Representative. SCAI Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Dr. Deborah D. Ascheim accepted a position at Capricor Therapeutics in August 2015, after the writing effort was completed. In accordance with ACC/AHA policy, she recused herself from the final voting process. ACP Representative. ACEP Representative. Former Task Force member; current member during the writing effort
| | - David X Zhao
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendixes 1 and 2 for detailed information. ACC/AHA Representative. SCAI Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Dr. Deborah D. Ascheim accepted a position at Capricor Therapeutics in August 2015, after the writing effort was completed. In accordance with ACC/AHA policy, she recused herself from the final voting process. ACP Representative. ACEP Representative. Former Task Force member; current member during the writing effort
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2015 ACC/AHA/SCAI Focused Update on Primary Percutaneous Coronary Intervention for Patients With ST-Elevation Myocardial Infarction: An Update of the 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention and the 2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction. J Am Coll Cardiol 2015; 67:1235-1250. [PMID: 26498666 DOI: 10.1016/j.jacc.2015.10.005] [Citation(s) in RCA: 580] [Impact Index Per Article: 64.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Early occlusion of the non-infarct-related coronary artery following successful primary percutaneous coronary intervention in ST-elevation myocardial infarction. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2015; 11:136-40. [PMID: 26161106 PMCID: PMC4495130 DOI: 10.5114/pwki.2015.52287] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 02/04/2015] [Accepted: 02/12/2015] [Indexed: 11/18/2022] Open
Abstract
We present a clinical case of early occlusion of the non-infarct-related artery (non-IRA) in a patient with ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (pPCI). Several hours after successful percutaneous treatment of the occluded right coronary artery the patient developed a second myocardial infarction, which was caused by acute occlusion of the left anterior descending artery, which had a significant lesion in the proximal segment. The lesion was diagnosed during the first catheterization, but was left untreated. We discuss the potential advantages and risks associated with the ad-hoc multivessel PCI strategy in STEMI.
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Culprit vessel only versus "one-week" staged percutaneous coronary intervention for multivessel disease in patients presenting with ST-segment elevation myocardial infarction. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2015; 12:226-31. [PMID: 26089845 PMCID: PMC4460164 DOI: 10.11909/j.issn.1671-5411.2015.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 03/30/2015] [Accepted: 04/01/2015] [Indexed: 11/28/2022]
Abstract
Objective To explore the impact of a “one-week” staged multivessel percutaneous coronary intervention (PCI) versus culprit-only PCI on deaths and major adverse cardiac events (MACE). Methods We retrospectively analyzed 447 patients with multivessel disease who experienced a ST-segment elevation myocardial infarction (STEMI) within 12 h before undergoing PCI between July 26, 2008 and September 25, 2011. After completion of PCI in the infarct artery, 201 patients still in the hospital agreed to undergo PCI in non-infarct arteries with more than 70% stenosis for a “one-week” staged multivessel PCI. A total of 246 patients only received intervention for the culprit vessel. Follow-up ended on September 9, 2014. This study examined the differences in deaths from any cause (i.e., cardiac and noncardiac) and MACE between the two treatment groups. Results Compared to a culprit-only PCI treatment approach, the “one-week” staged multivessel PCI was strongly associated with greater benefits for 55-month all cause death [41 (16.7%) vs.13 (6.5%), P = 0.004] and MACE [82 (33.3%) vs. 40 (19.9%), P = 0.002] rates. In addition, there were significant differences in the number of myocardial infarctions [43 (17.5%) vs. 20 (10.0%), P = 0.023], coronary-artery bypass grafting [CABG; 20 (8.1%) vs. 6 (3.0%), P = 0.021], and PCI [31 (12.6%) vs. 12 (6.0%), P = 0.018]. Patients undergoing culprit-only PCI compared to “one-week” PCI had the same number of stent thrombosis events [7 (2.8%) vs. 3 (1.5%), P = 0.522]. Conclusions Compared to a culprit-only PCI treatment approach, “one-week” staged multi-vessel PCI was a safe and effective selection for STEMI and multi-vessel PCI.
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El-Hayek GE, Gershlick AH, Hong MK, Casso Dominguez A, Banning A, Afshar AE, Herzog E, Tamis-Holland JE. Meta-Analysis of Randomized Controlled Trials Comparing Multivessel Versus Culprit-Only Revascularization for Patients With ST-Segment Elevation Myocardial Infarction and Multivessel Disease Undergoing Primary Percutaneous Coronary Intervention. Am J Cardiol 2015; 115:1481-6. [PMID: 25840579 DOI: 10.1016/j.amjcard.2015.02.046] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2014] [Revised: 02/26/2015] [Accepted: 02/26/2015] [Indexed: 10/23/2022]
Abstract
Current guidelines recommend against revascularization of the noninfarct artery during the index percutaneous coronary intervention (PCI) in hemodynamically stable patients with ST-segment elevation myocardial infarction (STEMI). This was based largely on observational studies with few data coming from randomized controlled trials (RCTs). Recently, several small-to-moderate sized RCTs have provided data, suggesting that a multivessel revascularization approach may be appropriate. We performed a meta-analysis of RCTs comparing multivessel percutaneous coronary intervention (MV PCI) versus culprit vessel-only revascularization (COR) during primary PCI in patients with STEMI and multivessel coronary disease (MVCD). We searched Medline, PubMed, and Scopus databases for RCTs comparing MV PCI versus COR in patients with STEMI and MVCD. The incidence of all-cause death, cardiac death, recurrent myocardial infarction, and revascularization during follow-up were extracted. Four RCTs fit our primary selection criteria. Among these, 566 patients underwent MV PCI (either at the time of the primary PCI or as a staged procedure) and 478 patients underwent COR. During long-term follow-up (range 1 to 2.5 years), combined data indicated a significant reduction in all-cause mortality (relative risk [RR] 0.57, 95% confidence interval [CI] 0.36 to 0.92, p = 0.02) and in cardiac death (RR 0.38, 95% CI 0.20 to 0.73, p = 0.004) with MV PCI. In addition, there was a significantly lower risk of recurrent myocardial infarction (RR 0.41, 95% CI 0.23 to 0.75; p = 0.004) and future revascularization (RR 0.37, 95% CI 0.27 to 0.52; p <0.00001). In conclusion, from the RCT data, MV PCI appears to improve outcomes in patients with STEMI and MVCD.
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Bittl JA, Tamis-Holland JE, Lang CD, He Y. Outcomes after multivessel or culprit-Vessel intervention for ST-elevation myocardial infarction in patients with multivessel coronary disease: A Bayesian cross-design meta-analysis. Catheter Cardiovasc Interv 2015; 86 Suppl 1:S15-22. [DOI: 10.1002/ccd.26025] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 04/06/2015] [Accepted: 04/18/2015] [Indexed: 11/06/2022]
Affiliation(s)
| | | | | | - Yulei He
- Office of Research and Methodology; National Center for Health Statistics, Centers for Disease Control and Prevention; Hyattsville Maryland
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Yeh RW, Drachman DE. Culprit only, multivessel, or staged multivessel intervention in STEMI: New insights or insurmountable methodologic obstacles? Catheter Cardiovasc Interv 2014; 84:923-4. [DOI: 10.1002/ccd.25673] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2014] [Accepted: 09/19/2014] [Indexed: 11/10/2022]
Affiliation(s)
- Robert W. Yeh
- Cardiology Division, Massachusetts General Hospital; Harvard Medical School; Boston Massachusetts
| | - Douglas E. Drachman
- Cardiology Division, Massachusetts General Hospital; Harvard Medical School; Boston Massachusetts
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