Prognosis of complete versus incomplete revascularisation of patients with STEMI with multivessel coronary artery disease: an observational study.
(2017) Open Heart — Vol. 4, n° 1, p. e000541 (2017)
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- The best strategy in patients with acute ST-segment elevation myocardial infarction (STEMI) with multivessel coronary artery disease (CAD) regarding completeness of revascularisation of the non-culprit lesion(s) is still unclear. To establish which strategy should be followed, survival rates over a longer period should be evaluated. The aim of this study was to investigate whether complete revascularisation, compared with incomplete revascularisation, is associated with reduced short-term and long-term all-cause mortality in patients with first STEMI and multivessel CAD. This retrospective study consisted of 518 patients with first STEMI with multivessel CAD. Complete revascularisation (45%) was defined as the treatment of any significant coronary artery stenosis (≥70% luminal narrowing) during primary or staged percutaneous coronary intervention prior to discharge. The primary end point was all-cause mortality. Incomplete revascularisation was not independently associated with 30-day all-cause mortality in patients with acute first STEMI and multivessel CAD (OR 1.98; 95% CI 0.62to6.37; p=0.25). During a median long-term follow-up of 6.7 years, patients with STEMI with multivessel CAD and incomplete revascularisation showed higher mortality rates compared with patients who received complete revascularisation (24% vs 12%, p<0.001), and these differences remained after excluding the first 30 days. However, in multivariate analysis, incomplete revascularisation was not independently associated with increased all-cause mortality during long-term follow-up in the group of patients with STEMI who survived the first 30 days post-STEMI (HR 1.53 95% CI 0.89-2.61, p=0.12). In patients with acute first STEMI and multivessel CAD, incomplete revascularisation compared with complete revascularisation was not independently associated with increased short-term and long-term all-cause mortality.
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Dimitriu-Leen, A. C., Hermans, M., Veltman, C. E., van der Hoeven, B. L., van Rosendael, A. R., van Zwet, E. W., Schalij, M. J., Delgado, V., Bax, J. J., & Scholte, A. J. H. A. (2017). Prognosis of complete versus incomplete revascularisation of patients with STEMI with multivessel coronary artery disease: an observational study. Open Heart, 4(1), e000541. https://doi.org/10.1136/openhrt-2016-000541 (Original work published 2017)