BACKGROUND:Older adults presenting with acute myocardial infarction (MI) often have multivessel coronary artery disease amenable to percutaneous coronary intervention (PCI), yet the risks of multivessel intervention may outweigh potential benefits in these patients. We sought to determine if nonculprit intervention during the index PCI is associated with better outcomes among older patients with acute MI and multivessel disease. METHODS: We examined 19,271 ST-segment elevation MI (STEMI) and 31,361 non-STEMI (NSTEMI) patients 65years or older with multivessel disease in a linked CathPCI Registry-Medicare database, excluding patients with prior coronary artery bypass grafting, left main disease, or cardiogenic shock. Using inverse probability-weighted propensity adjustment, we compared mortality between patients receiving culprit-only vs multivessel intervention during the index PCI procedure. RESULTS: Most older MI patients (91% STEMI and 74% NSTEMI) received culprit-only intervention during the index PCI. Among STEMI patients, multivessel intervention during the index PCI was associated with higher 30-day mortality (8.3% vs 6.3%, adjusted hazard ratio [HR] 1.36, 95% CI 1.14-1.62) than culprit-only intervention, and this trend persisted at 1year (13.8% vs 12.2%, adjusted HR 1.14, 95% CI 0.99-1.31). No significant mortality differences were observed among NSTEMI patients at 30days (3.4% vs 4.1%, adjusted HR 1.01, 95% CI 0.88-1.15) or at 1year (10.1% vs 10.8%, adjusted HR 0.99, 95% CI 0.91-1.08). CONCLUSIONS:Nonculprit intervention during the index PCI was associated with worse outcomes among STEMI patients, but not NSTEMI patients.
RCT Entities:
BACKGROUND: Older adults presenting with acute myocardial infarction (MI) often have multivessel coronary artery disease amenable to percutaneous coronary intervention (PCI), yet the risks of multivessel intervention may outweigh potential benefits in these patients. We sought to determine if nonculprit intervention during the index PCI is associated with better outcomes among older patients with acute MI and multivessel disease. METHODS: We examined 19,271 ST-segment elevation MI (STEMI) and 31,361 non-STEMI (NSTEMI) patients 65years or older with multivessel disease in a linked CathPCI Registry-Medicare database, excluding patients with prior coronary artery bypass grafting, left main disease, or cardiogenic shock. Using inverse probability-weighted propensity adjustment, we compared mortality between patients receiving culprit-only vs multivessel intervention during the index PCI procedure. RESULTS: Most older MI patients (91% STEMI and 74% NSTEMI) received culprit-only intervention during the index PCI. Among STEMI patients, multivessel intervention during the index PCI was associated with higher 30-day mortality (8.3% vs 6.3%, adjusted hazard ratio [HR] 1.36, 95% CI 1.14-1.62) than culprit-only intervention, and this trend persisted at 1year (13.8% vs 12.2%, adjusted HR 1.14, 95% CI 0.99-1.31). No significant mortality differences were observed among NSTEMI patients at 30days (3.4% vs 4.1%, adjusted HR 1.01, 95% CI 0.88-1.15) or at 1year (10.1% vs 10.8%, adjusted HR 0.99, 95% CI 0.91-1.08). CONCLUSIONS: Nonculprit intervention during the index PCI was associated with worse outcomes among STEMI patients, but not NSTEMI patients.
Authors: Simone Biscaglia; Vincenzo Guiducci; Andrea Santarelli; Ignacio Amat Santos; Francisco Fernandez-Aviles; Valerio Lanzilotti; Ferdinando Varbella; Luca Fileti; Raul Moreno; Francesco Giannini; Iginio Colaiori; Mila Menozzi; Alfredo Redondo; Marco Ruozzi; Enrique Gutiérrez Ibañes; José Luis Díez Gil; Elisa Maietti; Giuseppe Biondi Zoccai; Javier Escaned; Matteo Tebaldi; Emanuele Barbato; Dariusz Dudek; Antonio Colombo; Gianluca Campo Journal: Am Heart J Date: 2020-08-18 Impact factor: 4.749
Authors: Ada Del Mar Carmona-Segovia; María Victoria Doncel-Abad; Víctor M Becerra-Muñoz; Jorge Rodríguez-Capitán; Fernando Sabatel-Pérez; María Flores-López; María José Sánchez-Quintero; Dina Medina-Vera; Ana Isabel Molina-Ramos; Rajaa El Bekay; José Miguel Morales-Asencio; María Angullo-Gómez; Luis García-Rodríguez; Lucía Palma-Martí; Francisco Javier Pavón-Morón; Manuel F Jiménez-Navarro Journal: BMJ Open Date: 2022-02-28 Impact factor: 2.692
Authors: Eric A Secemsky; Neel Butala; Aishwarya Raja; Rohan Khera; Yongfei Wang; Jeptha P Curtis; Thomas M Maddox; Salim S Virani; Ehrin J Armstrong; Kendrick A Shunk; Ralph G Brindis; Deepak Bhatt; Robert W Yeh Journal: Circ Cardiovasc Interv Date: 2021-08-10 Impact factor: 7.514
Authors: Rohan Khera; Eric A Secemsky; Yongfei Wang; Nihar R Desai; Harlan M Krumholz; Thomas M Maddox; Kendrick A Shunk; Salim S Virani; Deepak L Bhatt; Jeptha Curtis; Robert W Yeh Journal: JAMA Intern Med Date: 2020-10-01 Impact factor: 44.409
Authors: Homam Ibrahim; Praneet K Sharma; David J Cohen; Gregg C Fonarow; Lisa A Kaltenbach; Mark B Effron; Marjorie E Zettler; Eric D Peterson; Tracy Y Wang Journal: J Am Heart Assoc Date: 2017-10-05 Impact factor: 5.501