Comparison of infarct-related artery vs multivessel revascularization in ST-segment elevation myocardial infarction with multivessel disease: analysis from Korea Acute Myocardial Infarction Registry

• Published in: Cardiology journal 2012, Vol.19 (3), p.256-266
• Main Authors: Lee, Hye Won, Hong, Taek Jong, Yang, Mi Jin, An, Sung Gyu, Oh, Jun-Hyok, Choi, Jung Hyun, Lee, Han Cheol, Cha, Kwang Soo, Hong, Ju Young
• Format: Article
• Language: English
• Subjects: Aged; Angioplasty, Balloon, Coronary - adverse effects; Angioplasty, Balloon, Coronary - mortality; Chi-Square Distribution; Clinical outcomes; Coronary Angiography; Coronary Artery Disease - complications; Coronary Artery Disease - diagnostic imaging; Coronary Artery Disease - mortality; Coronary Artery Disease - therapy; Coronary Thrombosis - etiology; Female; Heart attacks; Hospital Mortality; Humans; Logistic Models; Male; Middle Aged; Multivariate Analysis; Myocardial Infarction - etiology; Myocardial Infarction - mortality; Myocardial Infarction - therapy; Odds Ratio; Predictive Value of Tests; Proportional Hazards Models; Prospective Studies; Recurrence; Registries; Republic of Korea; Risk Assessment; Risk Factors; Severity of Illness Index; Stents; Thrombosis; Time Factors; Treatment Outcome
• ISSN: 1897-5593; 1897-5593; 1898-018X
• DOI: 10.5603/CJ.2012.0047

Many ST-segment elevation myocardial infarction (STEMI) patients have multivessel disease. There is still controversy in treatment strategy in STEMI patients with multivessel disease. We compared clinical outcomes of multivessel revascularization with infarct- related artery (IRA) revascularization in STEMI patients. The 1,644 STEMI patients with multivessel disease (1,106 in IRA group, 538 in multivessel group) who were received primary percutaneous coronary intervention (PCI) were analyzed from a nationwide Korea Acute Myocardial Infarction Registry. Primary endpoint was 12-month major adverse cardiac events (MACE, defined as death, myocardial infarction, and repeated revascularization). Secondary endpoints were 1-month MACE and each component, stent thrombosis during 12 month follow-up, and each components of the 12-month MACE. There were more patients with unfavorable baseline conditions in IRA group. 12-month MACE occurred in 165 (14.9%) patients in IRA group, 81 (15.1%) patients in multivessel group (p = 0.953). There were no statistical significance in the rate of 1-month MACE, each components of 1-month MACE, and stent thrombosis during 12 month follow-up. Each components of 12-month MACE were occurred similarly in both groups except for target lesion revascularization (2.4% in IRA group vs 5.9% in multivessel group, p < 0.0001). After adjusting for confounding factors, multivessel revascularization was not associated with reduced 12-month MACE (OR 1.096, 95% CI 0.676-1.775, p = 0.711). There were no significant differences in clinical outcomes between both groups except for high risk of target lesion revascularization in multivessel revascularization group.