Korean Circ J.  2020 Mar;50(3):220-233. 10.4070/kcj.2019.0176.

One-Year Clinical Outcomes between Single- versus Multi-Staged PCI for ST Elevation Myocardial Infarction with Multi-Vessel Coronary Artery Disease: from Korea Acute Myocardial Infarction Registry-National Institute of Health (KAMIR-NIH)

Affiliations
  • 1Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea. jojeong@cnu.ac.kr
  • 2Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea.
  • 3Division of Cardiology, Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea.
  • 4Division of Cardiology, Department of Internal Medicine, Yeungnam University Hospital, Daegu, Korea.
  • 5Division of Cardiology, Department of Internal Medicine, Kyunghee University College of Medicine, Seoul, Korea.
  • 6Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
  • 7Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Korea.
  • 8Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Korea.

Abstract

BACKGROUND AND OBJECTIVES
Although complete revascularization is known superior to incomplete revascularization in ST elevation myocardial infarction (STEMI) patients with multi-vessel coronary artery disease (MVCD), there are no definite instructions on the optimal timing of non-culprit lesions percutaneous coronary intervention (PCI). We compared 1-year clinical outcomes between 2 different complete multi-vessel revascularization strategies.
METHODS
From the Korea Acute Myocardial Infarction Registry-National Institute of Health, 606 patients with STEMI and MVCD who underwent complete revascularization were enrolled from November 2011 to December 2015. The patients were assigned to multi-vessel single-staged PCI (SS PCI) group (n=254) or multi-vessel multi-staged PCI (MS PCI) group (n=352). Propensity score matched 1-year clinical outcomes were compared between the groups.
RESULTS
At one year, MS PCI showed a significantly lower rate of all-cause mortality (hazard ratio [HR], 0.42; 95% confidential interval [CI], 0.19-0.92; p=0.030) compared with SS PCI. In subgroup analysis, all-cause mortality increased in SS PCI with cardiogenic shock (HR, 4.60; 95% CI, 1.54-13.77; p=0.006), age ≥65 years (HR, 4.00; 95% CI, 1.67-9.58, p=0.002), Killip class III/IV (HR, 7.32; 95% CI, 1.68-31.87; p=0.008), and creatinine clearance ≤60 mL/min (HR, 2.81; 95% CI, 1.10-7.18; p=0.031). After propensity score-matching, MS PCI showed a significantly lower risk of major adverse cardiovascular event than SS PCI.
CONCLUSIONS
SS PCI was associated with worse clinical outcomes compared with MS PCI. MS PCI for non-infarct-related artery could be a better option for patients with STEMI and MVCD, especially high-risk patients.

Keyword

Myocardial infarction; Percutaneous coronary intervention; Myocardial revascularization; Coronary artery disease

MeSH Terms

Arteries
Coronary Artery Disease*
Coronary Vessels*
Creatinine
Humans
Korea*
Mortality
Myocardial Infarction*
Myocardial Revascularization
Percutaneous Coronary Intervention
Propensity Score
Shock, Cardiogenic
Creatinine
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