You are here

  • Home
  • Archive
  • Volume 4, Issue 1
  • Prognosis of complete versus incomplete revascularisation of patients with STEMI with multivessel coronary artery disease: an observational study

Article Text

Article menu

Download PDFPDF

Interventional cardiology
Original research article
Prognosis of complete versus incomplete revascularisation of patients with STEMI with multivessel coronary artery disease: an observational study
  1. Aukelien C Dimitriu-Leen1⇑,
  2. Maaike P J Hermans1,
  3. Caroline E Veltman1,
  4. Bas L van der Hoeven2,
  5. Alexander R van Rosendael1,3,
  6. Erik W van Zwet4,
  7. Martin J Schalij1,
  8. Victoria Delgado1,
  9. Jeroen J Bax1 and
  10. Arthur J H A Scholte1
  1. 1 Department of Cardiology, Leids Universitair Medisch Centrum, Leiden, The Netherlands
  2. 2 Department of Cardiology, Medical Center Haaglanden, Hague, The Netherlands
  3. 3 Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands
  4. 4 Department of Medical Statistics and Bio-informatics, Leiden University Medical Center, Leiden, The Netherlands
  1. Correspondence to Aukelien C Dimitriu-Leen; a.c.dimitriu-leen{at}lumc.nl

Abstract

Objective The best strategy in patients with acute ST-segment elevation myocardial infarction (STEMI) with multivessel coronary artery disease (CAD) regarding completeness of revascularisation of the non-culprit lesion(s) is still unclear. To establish which strategy should be followed, survival rates over a longer period should be evaluated. The aim of this study was to investigate whether complete revascularisation, compared with incomplete revascularisation, is associated with reduced short-term and long-term all-cause mortality in patients with first STEMI and multivessel CAD.

Methods This retrospective study consisted of 518 patients with first STEMI with multivessel CAD. Complete revascularisation (45%) was defined as the treatment of any significant coronary artery stenosis (≥70% luminal narrowing) during primary or staged percutaneous coronary intervention prior to discharge. The primary end point was all-cause mortality.

Results Incomplete revascularisation was not independently associated with 30-day all-cause mortality in patients with acute first STEMI and multivessel CAD (OR 1.98; 95% CI 0.62to6.37; p=0.25). During a median long-term follow-up of 6.7 years, patients with STEMI with multivessel CAD and incomplete revascularisation showed higher mortality rates compared with patients who received complete revascularisation (24% vs 12%, p<0.001), and these differences remained after excluding the first 30 days. However, in multivariate analysis, incomplete revascularisation was not independently associated with increased all-cause mortality during long-term follow-up in the group of patients with STEMI who survived the first 30 days post-STEMI (HR 1.53 95% CI 0.89-2.61, p=0.12).

Conclusion In patients with acute first STEMI and multivessel CAD, incomplete revascularisation compared with complete revascularisation was not independently associated with increased short-term and long-term all-cause mortality.

  • All-cause mortality
  • complete revascularization
  • multi-vessel disease
  • primary percutaneous coronary intervention

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/openhrt-2016-000541

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    View Full Text

    Footnotes

    • Contributors All authors have contributed significantly to the submitted work and approved submission of the manuscript.

    • Funding The Department of Cardiology has received research grants from Biotronik, Medtronic, Boston Scientific Corporation and Edwards Lifesciences.

    • Competing interests VD received speaking fees from Abbott Vascular.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement No additional unpublished data is available without consulting the authors.