TY - JOUR
T1 - Prevalence, Predictors, and In-Hospital Outcomes of Non-Infarct Artery Intervention During Primary Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction (from the National Cardiovascular Data Registry)
AU - Cavender, Matthew A.
AU - Milford-Beland, Sarah
AU - Roe, Matthew T.
AU - Peterson, Eric D.
AU - Weintraub, William S.
AU - Rao, Sunil V.
N1 - Funding Information:
This analysis was supported by a grant from the American College of Cardiology, Washington, DC, and the Society for Cardiac Angiography and Interventions, Washington, DC.
Funding Information:
This analysis was supported by the National Cardiovascular Data Registry.
Funding Information:
Dr. Roe was supported by research grants from Schering Plough, BMS/Sanofi-Aventis, KAI Pharmaceuticals, and DeCODE Genetics; is on the consulting/advisory boards for Schering Plough, KAI Pharmaceuticals; and is on the Speakers Bureau or has received honoraria from Schering Plough and BMS/Sanofi-Aventis.
Funding Information:
Dr. Rao is a Consultant for Sanofi-Aventis and member of the Speakers' Bureaus for Sanofi-Aventis, Bristol Myers Squibb, and the Medicines Company and has received research funding from Momenta Pharmaceuticals, Portola Pharmaceuticals, and Cordis.
PY - 2009/8/15
Y1 - 2009/8/15
N2 - Guidelines support percutaneous coronary intervention (PCI) of the noninfarct-related artery during primary PCI for ST-segment elevation myocardial infarction (STEMI) in patients with hemodynamic compromise; however, in patients without hemodynamic compromise, PCI of the noninfarct-related artery is given a class III recommendation. We analyzed the National Cardiovascular Data Registry (n = 708,481 admissions, 638 sites) to determine the prevalence, predictors, and in-hospital outcomes of primary multivessel PCI from 2004 to 2007. Patients with STEMI and multivessel coronary artery disease who were undergoing primary PCI were identified (n = 31,681). After excluding the patients treated with staged PCI (n = 2,745), 10.8% (n = 3,134) of the remaining population (n = 28,936) were treated with multivessel PCI. Patients undergoing multivessel PCI were at higher risk and were more likely to be in cardiogenic shock. The overall in-hospital mortality rates were greater in patients undergoing multivessel PCI (7.9% vs 5.1%, p <0.01). Among patients with STEMI and cardiogenic shock (n = 3,087), those receiving multivessel PCI had greater in-hospital mortality (36.5% vs 27.8%; adjusted odds ratio 1.54, 95% confidence interval 1.22 to 1.95). In conclusion, these data suggest that performing multivessel PCI during primary PCI for STEMI does not improve short-term survival even for patients with cardiogenic shock. These findings suggest the need for definitive studies to evaluate the utility of noninfarct-related artery PCI among patients with STEMI.
AB - Guidelines support percutaneous coronary intervention (PCI) of the noninfarct-related artery during primary PCI for ST-segment elevation myocardial infarction (STEMI) in patients with hemodynamic compromise; however, in patients without hemodynamic compromise, PCI of the noninfarct-related artery is given a class III recommendation. We analyzed the National Cardiovascular Data Registry (n = 708,481 admissions, 638 sites) to determine the prevalence, predictors, and in-hospital outcomes of primary multivessel PCI from 2004 to 2007. Patients with STEMI and multivessel coronary artery disease who were undergoing primary PCI were identified (n = 31,681). After excluding the patients treated with staged PCI (n = 2,745), 10.8% (n = 3,134) of the remaining population (n = 28,936) were treated with multivessel PCI. Patients undergoing multivessel PCI were at higher risk and were more likely to be in cardiogenic shock. The overall in-hospital mortality rates were greater in patients undergoing multivessel PCI (7.9% vs 5.1%, p <0.01). Among patients with STEMI and cardiogenic shock (n = 3,087), those receiving multivessel PCI had greater in-hospital mortality (36.5% vs 27.8%; adjusted odds ratio 1.54, 95% confidence interval 1.22 to 1.95). In conclusion, these data suggest that performing multivessel PCI during primary PCI for STEMI does not improve short-term survival even for patients with cardiogenic shock. These findings suggest the need for definitive studies to evaluate the utility of noninfarct-related artery PCI among patients with STEMI.
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U2 - 10.1016/j.amjcard.2009.04.016
DO - 10.1016/j.amjcard.2009.04.016
M3 - Article
C2 - 19660603
AN - SCOPUS:67849133767
SN - 0002-9149
VL - 104
SP - 507
EP - 513
JO - American Journal of Cardiology
JF - American Journal of Cardiology
IS - 4
ER -