Comparison of clinical outcomes between culprit vessel only and multivessel percutaneous coronary intervention for ST-segment elevation myocardial infarction patients with multivessel coronary diseases

Kwang Sun Ryu; Hyun Woo Park; Soo Ho Park; Ho Sun Shon; Keun Ho Ryu; Dong Gyu Lee; Mohamed Ea Bashir; Ju Hee Lee; Sang Min Kim; Sang Yeub Lee; Jang Whan Bae; Kyung Kuk Hwang; Dong Woon Kim; Myeong Chan Cho; Young Keun Ahn; Myung Ho Jeong; Chong Jin Kim; Jong Seon Park; Young Jo Kim; Yang Soo Jang; Hyo Soo Kim; Ki Bae Seung; other Korea Acute Myocardial Infarction Registry Investigators

doi:10.11909/j.issn.1671-5411.2015.03.014

Comparison of clinical outcomes between culprit vessel only and multivessel percutaneous coronary intervention for ST-segment elevation myocardial infarction patients with multivessel coronary diseases

J Geriatr Cardiol. 2015 May;12(3):208-17. doi: 10.11909/j.issn.1671-5411.2015.03.014.

Authors

Kwang Sun Ryu¹, Hyun Woo Park¹, Soo Ho Park¹, Ho Sun Shon¹, Keun Ho Ryu¹, Dong Gyu Lee², Mohamed Ea Bashir³, Ju Hee Lee⁴, Sang Min Kim⁴, Sang Yeub Lee⁴, Jang Whan Bae⁵, Kyung Kuk Hwang⁵, Dong Woon Kim⁵, Myeong Chan Cho⁵, Young Keun Ahn⁶, Myung Ho Jeong⁶, Chong Jin Kim⁷, Jong Seon Park⁸, Young Jo Kim⁸, Yang Soo Jang⁹, Hyo Soo Kim¹⁰, Ki Bae Seung¹¹; other Korea Acute Myocardial Infarction Registry Investigators

Affiliations

¹ Database and Bioinformatics Laboratory, School of Electrical and Computer Engineering, Chungbuk National University, Cheongju, Chungbuk, South Korea.
² Human Genome Center, Institute of Medical Science, University of Tokyo, Minatoku, Tokyo, Japan.
³ Faculty of Computer Science and Information Technology, University of Medical Sciences and Technology, Khartoum, Sudan.
⁴ Regional Cardiovascular Disease Center, Chungbuk National University Hospital, Cheongju, Chungbuk, South Korea.
⁵ Regional Cardiovascular Disease Center, Chungbuk National University Hospital, Cheongju, Chungbuk, South Korea ; Division of Cardiology, Department of Internal Medicine, College of Medicine, Chungbuk National University, Cheongju, Chungbuk, South Korea.
⁶ Department of Cardiology, Chonnam National University Hospital, Donggu, Gwangju, South Korea.
⁷ Department of Internal Medicine, Kyunghee University Gangdong Hospital, Seoul, South Korea.
⁸ Department of Internal Medicine, Yeungnam University Hospital, Medical Center, Daegu, South Korea.
⁹ Division of Cardiology, Yonsei University, Severance Hospital, Seoul, South Korea.
¹⁰ Cardiovascular Center and Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea.
¹¹ Department of Cardiovascular Medicine, Catholic University, St. Mary's Hospital, Seoul, South Korea.

PMID: 26089843
PMCID: PMC4460162
DOI: 10.11909/j.issn.1671-5411.2015.03.014

Abstract

Background: The clinical significance of complete revascularization for ST segment elevation myocardial infarction (STEMI) patients during admission is still debatable.

Methods: A total of 1406 STEMI patients from the Korean Myocardial Infarction Registry with multivessel diseases without cardiogenic shock who underwent primary percutaneous coronary intervention (PPCI) were analyzed. We used propensity score matching (PSM) to control differences of baseline characteristics between culprit only intervention (CP) and multivessel percutaneous coronary interventions (MP), and between double vessel disease (DVD) and triple vessel disease (TVD). The major adverse cardiac event (MACE) was analyzed for one year after discharge.

Results: TVD patients showed higher incidence of MACE (14.2% vs. 8.6%, P = 0.01), any cause of revascularization (10.6% vs. 5.9%, P = 0.01), and repeated PCI (9.5% vs. 5.7%, P = 0.02), as compared to DVD patients during one year after discharge. MP reduced MACE effectively (7.3% vs. 13.8%, P = 0.03), as compared to CP for one year, but all cause of death (1.6% vs. 3.2%, P = 0.38), MI (0.4% vs. 0.8%, P = 1.00), and any cause of revascularization (5.3% vs. 9.7%, P = 0.09) were comparable in the two treatment groups.

Conclusions: STEMI patients with TVD showed higher rate of MACE, as compared to DVD. MP performed during PPCI or ad hoc during admission for STEMI patients without cardiogenic shock showed lower rate of MACE in this large scaled database. Therefore, MP could be considered as an effective treatment option for STEMI patients without cardiogenic shock.

Keywords: Culprit only intervention; Multivessel coronary disease; Multivessel intervention; Myocardial infarction; Primary percutaneous coronary intervention.