Jose M de La Torre Hernandez1, Joan A Gomez Hospital2, Jose A Baz3, Salvatore Brugaletta4, Armando Perez de Prado5, Jose A Linares6, Ramón Lopez Palop7, Belen Cid8, Tamara Garcia Camarero9, Alejandro Diego10, Hipolito Gutierrez11, Jose A Fernandez Diaz12, Juan Sanchis13, Fernando Alfonso14, Roberto Blanco15, Javier Botas16, Javier Navarro Cuartero17, Jose Moreu18, Francisco Bosa19, Jose M Vegas20, Jaime Elizaga21, Antonio L Arrebola22, Felipe Hernandez23, Neus Salvatella24, Marta Monteagudo25, Alfredo Gomez Jaume26, Xavier Carrillo27, Roberto Martin Reyes28, Fernando Lozano29, Jose R Rumoroso30, Leire Andraka31, Antonio J Dominguez32. 1. Hospital Universitario Marques de Valdecilla, Servicio de Cardiologia, Santander, Spain. Electronic address: he1thj@humv.es. 2. Hospital de Bellvitge, Barcelona, Spain. 3. Hospital de Vigo, Servicio de Cardiologia, Vigo, Spain. 4. Hospital Clinic, Servicio de Cardiologia, Barcelona, Spain. 5. Hospital de Leon, Leon, Servicio de Cardiologia, Spain. 6. Hospital Clinico de Zaragoza, Servicio de Cardiologia, Zaragoza, Spain. 7. Hospital San Juan, Servicio de Cardiologia, Alicante, Spain. 8. Hospital de Santiago de Compostela, Servicio de Cardiologia, Santiago de Compostela, Spain. 9. Hospital Universitario Marques de Valdecilla, Servicio de Cardiologia, Santander, Spain. 10. Hospital Clinico de Salamanca, Servicio de Cardiologia, Salamanca, Spain. 11. Hospital Clinico de Valladolid, Servicio de Cardiologia, Valladolid, Spain. 12. Hospital Puerta de Hierro, Servicio de Cardiologia, Madrid, Spain. 13. Hospital Clinico de Valencia, Servicio de Cardiologia, Valencia, Spain. 14. Hospital de la Princesa, Servicio de Cardiologia, Madrid, Spain. 15. Hospital de Cruces, Bilbao, Servicio de Cardiologia, Spain. 16. Hospital de Alcorcon, Servicio de Cardiologia, Alcorcon, Spain. 17. Hospital de Albacete, Servicio de Cardiologia, Albacete, Spain. 18. Hospital Virgen de la Salud, Servicio de Cardiologia, Toledo, Spain. 19. Hospital Clinico de Tenerife, Servicio de Cardiologia, Santa Cruz de Tenerife, Spain. 20. Hospital de Cabueñes, Servicio de Cardiologia, Gijon, Spain. 21. Hospital Gregorio Marañon, Servicio de Cardiologia, Madrid, Spain. 22. Hospital Virgen de las Nieves, Servicio de Cardiologia, Granada, Spain. 23. Hospital 12 de Octubre, Servicio de Cardiologia, Madrid, Spain. 24. Hospital del Mar, Servicio de Cardiología, Grup de Recerca Biomèdica en Malalties del Cor, IMIM (Hospital del Mar Reseach Institute), Barcelona, Spain. 25. Hospital Dr Peset, Servicio de Cardiologia, Valencia, Spain. 26. Hospital Son Espases, Servicio de Cardiologia, Palma de Mallorca, Spain. 27. Hospital Germans Trias i Pujol, Servicio de Cardiologia, Badalona, Spain. 28. Fundacion Jimenez Diaz, Servicio de Cardiologia, Madrid, Spain. 29. Hospital de Ciudad Real, Servicio de Cardiologia, Ciudad Real, Spain. 30. Hospital de Galdacano, Servicio de Cardiologia, Bilbao, Spain. 31. Hospital de Basurto, Servicio de Cardiologia, Bilbao, Spain. 32. Hospital Virgen de la Victoria, Servicio de Cardiologia, Malaga, Spain.
Abstract
BACKGROUND: In elderly patients with ST elevated myocardial infarction (STEMI) and multivessel disease (MVD the outcomes related with different revascularization strategies are not well known. METHODS: Subgroup-analysis of a nation-wide registry of primary angioplasty in the elderly (ESTROFA MI+75) with 3576 patients over 75years old from 31 centers. Patients with MVD were analyzed to describe treatment approaches and 2years outcomes. RESULTS: Of 1830 (51%) with MVD, 847 (46%) underwent multivessel revascularization either in acute (51%), staged (44%) or both procedures (5%). Patients with previous myocardial infarction and those receiving drug-eluting stents or IIb-IIIa inhibitors were more prone to be revascularized, whereas older patients, females and those with Killip III-IV, renal failure and higher ejection fraction were less likely. Survival free of cardiac death and infarction at 2years was better for those undergoing multivessel PCI (85.8% vs. 80.4%, p<0.0008), regardless of Killip class. Multivessel PCI was protective of cardiac death and infarction (HR 0.60, 95% CI 0.40-0.89; p=0.011). Complete revascularization made no difference in outcomes among those patients undergoing multivessel PCI. The best prognosis corresponded to those undergoing multivessel PCI in staged procedures (p<0.001). A propensity score matching analysis (514 patients in each group) yielded similar results. CONCLUSIONS: In elderly patients with STEMI and MVD, multivessel PCI was related with better outcomes especially after staged procedures. Among those undergoing multivessel PCI, anatomically defined completeness of revascularization had not prognostic influence. SUMMARY: We sought to investigate the revascularization strategies applied and their prognostic implications in patients aged over 75years with ST elevated myocardial infarction showing multivessel disease. Of 1830 patients, 847 (46%) underwent multivessel PCI either in acute (51%), staged (44%) or both procedures (5%). Multivessel PCI was independent predictor of cardiac death and infarction with the best prognosis corresponding to those undergoing staged procedures.
BACKGROUND: In elderly patients with ST elevated myocardial infarction (STEMI) and multivessel disease (MVD the outcomes related with different revascularization strategies are not well known. METHODS: Subgroup-analysis of a nation-wide registry of primary angioplasty in the elderly (ESTROFA MI+75) with 3576 patients over 75years old from 31 centers. Patients with MVD were analyzed to describe treatment approaches and 2years outcomes. RESULTS: Of 1830 (51%) with MVD, 847 (46%) underwent multivessel revascularization either in acute (51%), staged (44%) or both procedures (5%). Patients with previous myocardial infarction and those receiving drug-eluting stents or IIb-IIIa inhibitors were more prone to be revascularized, whereas older patients, females and those with Killip III-IV, renal failure and higher ejection fraction were less likely. Survival free of cardiac death and infarction at 2years was better for those undergoing multivessel PCI (85.8% vs. 80.4%, p<0.0008), regardless of Killip class. Multivessel PCI was protective of cardiac death and infarction (HR 0.60, 95% CI 0.40-0.89; p=0.011). Complete revascularization made no difference in outcomes among those patients undergoing multivessel PCI. The best prognosis corresponded to those undergoing multivessel PCI in staged procedures (p<0.001). A propensity score matching analysis (514 patients in each group) yielded similar results. CONCLUSIONS: In elderly patients with STEMI and MVD, multivessel PCI was related with better outcomes especially after staged procedures. Among those undergoing multivessel PCI, anatomically defined completeness of revascularization had not prognostic influence. SUMMARY: We sought to investigate the revascularization strategies applied and their prognostic implications in patients aged over 75years with ST elevated myocardial infarction showing multivessel disease. Of 1830 patients, 847 (46%) underwent multivessel PCI either in acute (51%), staged (44%) or both procedures (5%). Multivessel PCI was independent predictor of cardiac death and infarction with the best prognosis corresponding to those undergoing staged procedures.
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