BACKGROUND: The role of incomplete revascularization (ICR) in patients with acute myocardial infarction (AMI) is controversial. We evaluated the impact of ICR on short- and long-term outcome in patients with AMI and multivessel disease (MVD) treated with percutaneous coronary interventions (PCI) during index hospital stay. METHODS: Single-center observational study covered 798 patients with MVD selected from 1486 consecutive patients with AMI treated with PCI. At discharge, 605 (75.8%) of the patients still had at least 1 diseased artery (ICR group); in 193, complete revascularization (CR) has been achieved (CR group). Any-cause mortality rate and major adverse cardiac events (MACE) during hospitalization, within a follow-up period of 30 days and 29.7 months, were compared between both groups in the whole population and within the high-risk subgroups. Propensity model to predict the probability of CR according to 16 variables was used. RESULTS: Mortality and MACE rates were significantly higher in ICR group than among completely revascularized subjects during short- and long-term observation (remote mortality 18.5% vs 7.2%, MACE 53.1% vs 24.3%, both P < .001). Higher mortality rate was also observed within the subgroups with diabetes (25.2% vs 4.8%), renal dysfunction (44.1% vs 13.8%), and lowered ejection fraction (26.5% vs 10.5%, all P < .05). Propensity-adjusted multivariate analysis showed that ICR was a significant and strong predictor of remote death (propensity-adjusted hazard ratio 2.01, 95% CI 1.71-2.31, P = .02) and MACE (hazard ratio 2.08, 95% CI 1.90-2.26, P < .001). CONCLUSIONS: Incomplete revascularization is a strong and independent risk factor of death and MACE in patients with AMI treated with PCI.
BACKGROUND: The role of incomplete revascularization (ICR) in patients with acute myocardial infarction (AMI) is controversial. We evaluated the impact of ICR on short- and long-term outcome in patients with AMI and multivessel disease (MVD) treated with percutaneous coronary interventions (PCI) during index hospital stay. METHODS: Single-center observational study covered 798 patients with MVD selected from 1486 consecutive patients with AMI treated with PCI. At discharge, 605 (75.8%) of the patients still had at least 1 diseased artery (ICR group); in 193, complete revascularization (CR) has been achieved (CR group). Any-cause mortality rate and major adverse cardiac events (MACE) during hospitalization, within a follow-up period of 30 days and 29.7 months, were compared between both groups in the whole population and within the high-risk subgroups. Propensity model to predict the probability of CR according to 16 variables was used. RESULTS: Mortality and MACE rates were significantly higher in ICR group than among completely revascularized subjects during short- and long-term observation (remote mortality 18.5% vs 7.2%, MACE 53.1% vs 24.3%, both P < .001). Higher mortality rate was also observed within the subgroups with diabetes (25.2% vs 4.8%), renal dysfunction (44.1% vs 13.8%), and lowered ejection fraction (26.5% vs 10.5%, all P < .05). Propensity-adjusted multivariate analysis showed that ICR was a significant and strong predictor of remote death (propensity-adjusted hazard ratio 2.01, 95% CI 1.71-2.31, P = .02) and MACE (hazard ratio 2.08, 95% CI 1.90-2.26, P < .001). CONCLUSIONS: Incomplete revascularization is a strong and independent risk factor of death and MACE in patients with AMI treated with PCI.
Authors: Keun-Ho Park; Youngkeun Ahn; Myung Ho Jeong; Shung Chull Chae; Seung Ho Hur; Young Jo Kim; In Whan Seong; Jei Keon Chae; Taek Jong Hong; Myeong Chan Cho; Jang Ho Bae; Seung Woon Rha; Yang Soo Jang Journal: Korean J Intern Med Date: 2012-05-31 Impact factor: 2.884
Authors: Chuntao Wu; Anne-Marie Dyer; Spencer B King; Gary Walford; David R Holmes; Nicholas J Stamato; Ferdinand J Venditti; Samin K Sharma; Icilma Fergus; Alice K Jacobs; Edward L Hannan Journal: Circ Cardiovasc Interv Date: 2011-10-04 Impact factor: 6.546
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Authors: Chuntao Wu; Anne-Marie Dyer; Gary Walford; David R Holmes; Spencer B King; Nicholas J Stamato; Samin Sharma; Alice K Jacobs; Ferdinand J Venditti; Edward L Hannan Journal: Am J Cardiol Date: 2013-06-04 Impact factor: 2.778
Authors: Jae-Sik Jang; John A Spertus; Suzanne V Arnold; Ali Shafiq; Anna Grodzinsky; Timothy J Fendler; Adam C Salisbury; Fengming Tang; Edward J McNulty; J Aaron Grantham; David J Cohen; Amit P Amin Journal: J Am Coll Cardiol Date: 2015-11-10 Impact factor: 24.094