Etienne Puymirat1,2, Ariel Nakache1,2, Christophe Saint Etienne3, Pierre Marcollet4, Olivier Fichaux5, Marie-Pascale Decomis6, Stephan Chassaing7, Philippe Commeau8, Nicolas Danchin1,2, Guillaume Cayla9, Gilles Montalescot10, Hakim Benamer11, Rene Koning12, Pascal Motreff13, Grégoire Rangé14. 1. Department of Cardiology, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou, Paris, France. 2. Université de Paris, Paris, France. 3. Cardiology Department, Centre Hospitalo-Universitaire de Tours, Tours, France. 4. Cardiology Department, Centre Hospitalier de Bourges, Bourges, France. 5. Cardiology Department, Centre Hospitalo-régional d'Orléans, Orléans, France. 6. Cardiology Department, Clinique Oréliance, Saran, France. 7. Cardiology Department, Nouvelle Clinique Tourengelle, Tours, France. 8. Cardiology Department, Polyclinique les Fleurs, Ollioules, France. 9. Cardiology Department, CHU Nîmes, Université Montpellier, Nîmes, France. 10. Cardiology Department, Groupe hospitalier Pitié-Salpêtrière, Paris, France. 11. Cardiology Department, Clinique de la Roseraie; ICPS Massy Ramsay group, Paris 13, France. 12. Cardiology Department, Clinique Saint-Hilaire, Rouen, France. 13. Cardiology Department, Centre Hospitalo-Universitaire de Clermont-Ferrand, Clermont Ferrand, France. 14. Cardiology Department, Les Hôpitaux de Chartres, Chartres, France.
Abstract
BACKGROUND: ST-elevation myocardial infarction (STEMI) patients with multivessel disease (MVD) are associated with a worse prognosis. However, few comparisons are available according to coronary status in the era of modern reperfusion and optimized secondary prevention. HYPOTHESIS: We hypothesized that the difference in prognosis according to number of vessel disease in STEMI patients has reduced. METHODS: All consecutive STEMI patients undergoing primary percutaneous coronary intervention (PCI) within 24 h of symptoms onset between January 1, 2014 and June 30, 2016 enrolled in the CRAC (Club Régional des Angioplasticiens de la région Centre) France PCI registry were analyzed. Baseline characteristics, management, and outcomes at 1-year were analyzed according to coronary status (one-, two-, and three-VD). RESULTS: A total of 1886 patients (mean age 62.2 ± 14.0 year; 74% of male) were included. Patients with MVD (two or three-VD) represented 53.7%. They were older with higher cardiovascular risk factor profile. At 1 year, the rate of major adverse cardiovascular events (MACE, defined as all-cause death, stroke or re-MI) was 10%, 12%, and 12% in one-, two, and three-VD respectively (p = .28). In multivariable adjusted Cox proportional hazard regression model, two- and three-VD were not associated with higher rate of MACE compared to patients with single VD (HR, 1.09; 95%CI 0.76-1.56 for two-VD; HR, 0.74; 95%CI 0.48-1.14 for three-VD). CONCLUSIONS: MVD still represents an important proportion of STEMI patients but their prognoses were not associated with worse clinical outcomes at 1-year compared with one-VD patients in a modern reperfusion area and secondary medication prevention.
BACKGROUND: ST-elevation myocardial infarction (STEMI) patients with multivessel disease (MVD) are associated with a worse prognosis. However, few comparisons are available according to coronary status in the era of modern reperfusion and optimized secondary prevention. HYPOTHESIS: We hypothesized that the difference in prognosis according to number of vessel disease in STEMI patients has reduced. METHODS: All consecutive STEMI patients undergoing primary percutaneous coronary intervention (PCI) within 24 h of symptoms onset between January 1, 2014 and June 30, 2016 enrolled in the CRAC (Club Régional des Angioplasticiens de la région Centre) France PCI registry were analyzed. Baseline characteristics, management, and outcomes at 1-year were analyzed according to coronary status (one-, two-, and three-VD). RESULTS: A total of 1886 patients (mean age 62.2 ± 14.0 year; 74% of male) were included. Patients with MVD (two or three-VD) represented 53.7%. They were older with higher cardiovascular risk factor profile. At 1 year, the rate of major adverse cardiovascular events (MACE, defined as all-cause death, stroke or re-MI) was 10%, 12%, and 12% in one-, two, and three-VD respectively (p = .28). In multivariable adjusted Cox proportional hazard regression model, two- and three-VD were not associated with higher rate of MACE compared to patients with single VD (HR, 1.09; 95%CI 0.76-1.56 for two-VD; HR, 0.74; 95%CI 0.48-1.14 for three-VD). CONCLUSIONS: MVD still represents an important proportion of STEMI patients but their prognoses were not associated with worse clinical outcomes at 1-year compared with one-VD patients in a modern reperfusion area and secondary medication prevention.
Authors: Stephan Windecker; Philippe Kolh; Fernando Alfonso; Jean-Philippe Collet; Jochen Cremer; Volkmar Falk; Gerasimos Filippatos; Christian Hamm; Stuart J Head; Peter Jüni; A Pieter Kappetein; Adnan Kastrati; Juhani Knuuti; Ulf Landmesser; Günther Laufer; Franz-Josef Neumann; Dimitrios J Richter; Patrick Schauerte; Miguel Sousa Uva; Giulio G Stefanini; David Paul Taggart; Lucia Torracca; Marco Valgimigli; William Wijns; Adam Witkowski Journal: Eur Heart J Date: 2014-08-29 Impact factor: 29.983
Authors: G Rangé; S Chassaing; P Marcollet; C Saint-Étienne; P Dequenne; M Goralski; P Bardiére; F Beverilli; L Godillon; B Sabine; C Laure; S Gautier; R Hakim; F Albert; D Angoulvant; L Grammatico-Guillon Journal: Rev Epidemiol Sante Publique Date: 2018-04-21 Impact factor: 1.019
Authors: Robert W Yeh; Stephen Sidney; Malini Chandra; Michael Sorel; Joseph V Selby; Alan S Go Journal: N Engl J Med Date: 2010-06-10 Impact factor: 91.245
Authors: David S Wald; Joan K Morris; Nicholas J Wald; Alexander J Chase; Richard J Edwards; Liam O Hughes; Colin Berry; Keith G Oldroyd Journal: N Engl J Med Date: 2013-09-01 Impact factor: 91.245