Korean Circ J.  2011 Dec;41(12):718-725. 10.4070/kcj.2011.41.12.718.

Culprit-Lesion-Only Versus Multivessel Revascularization Using Drug-Eluting Stents in Patients With ST-Segment Elevation Myocardial Infarction: A Korean Acute Myocardial Infarction Registry-Based Analysis

• Jo HS
• Park JS
• Sohn JW
• Yoon JC
• Sohn CW
• Lee SH
• Hong GR
• Shin DG
• Kim YJ
• Jeong MH
• Chae SC
• Hur SH
• Hong TJ
• Seong IW
• Chae JK
• Rhew JY
• Chae IH
• Cho MC
• Bae JH
• Rha SW
• Kim CJ
• Choi DH
• Jang YS
• Yoon JH
• Chung WS
• Seung KB
• Park SJ

• KMID: 1776247
• DOI: http://doi.org/10.4070/kcj.2011.41.12.718

Abstract

BACKGROUND AND OBJECTIVES
In patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease, complete revascularization (CR) for non-culprit lesions is not routinely recommended. The aim of this study was to compare the clinical outcomes of multivessel compared with infarct-related artery (IRA)-only revascularization in patients undergoing primary percutaneous coronary intervention (PCI) for STEMI.
SUBJECTS AND METHODS
From the Korean Acute Myocardial Infarction Registry (KAMIR) database, 1,094 STEMI patients with multivessel disease who underwent primary PCI with drug-eluting stents were enrolled in this study. The patients were divided into two groups: culprit-vessel-only revascularization (COR, n=827) group; multivessel revascularization, including non-IRA (MVR, n=267) group. The primary endpoint of this study included major adverse cardiac events (MACEs), such as death, myocardial infarction, or target or nontarget lesion revascularization at one year.
RESULTS
There was no difference in clinical characteristics between the two groups. During the one-year follow-up, 102 (15.2%) patients in the COR group and 32 (14.2%) in the MVR group experienced at least one MACE (p=0.330). There were no differences between the two groups in terms of rates of death, myocardial infarction, or revascularization (2.1% vs. 2.0%, 0.7% vs. 0.8%, and 11.7% vs. 10.1%, respectively; p=0.822, 0.910, and 0.301, respectively). The MACE rate was higher in the incompletely revascularized patients than in the completely revascularized patients (15% vs. 9.5%, p=0.039), and the difference was attributable to a higher rate of nontarget vessel revascularization (8.6% vs. 1.8%, p=0.002).
CONCLUSION
Although multivessel angioplasty during primary PCI for STEMI did not reduce the MACE rate compared with culprit-vessel-only PCI, CR was associated with a lower rate of repeat revascularization after multivessel PCI.

Keyword

Myocardial infarction; Coronary artery disease; Angioplasty

MeSH Terms

Angioplasty
Arteries
Coronary Artery Disease
Drug-Eluting Stents
Follow-Up Studies
Glycosaminoglycans
Humans
Myocardial Infarction
Percutaneous Coronary Intervention
Glycosaminoglycans

Figure

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  Fig. 1 Flowchart of patients who participated in the study. KAMIR: Korean Acute Myocardial Infarction Registry, NSTEMI: non-ST-elevation myocardial infarction, STEMI: ST-elevation myocardial infarction, PCI: percutaneous coronary intervention, BMS: bare-metal stent, CPR: cardiopulmonary resuscitation, BP: blood pressure, DES: drug-eluting stent, COR: culprit-vessel-only revascularization, MVR: multivessel revascularization, CR: complete revascularization, IR: incomplete revascularization.

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  Fig. 2 One-year MACE-free survival in the COR and MVR groups. MACE: major adverse cardiac event, COR: culprit-vessel-only revascularization, MVR: multivessel revascularization.

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  Fig. 3 A: one-year MACE-free survival in the CR and IR subgroups. B: one-year nontarget vessel percutaneous coronary intervention-free survival in the CR and IR subgroups. MACE: major adverse cardiac event, CR: complete revascularization, IR: Incomplete revascularization.

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