Importance of complete revascularization in patients with acute myocardial infarction treated with percutaneous coronary intervention

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) duri...

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Published in:The American heart journal 2007-02, Vol.153 (2), p.304-312
Main Authors: Kalarus, Zbigniew, MD, Lenarczyk, Radosław, MD, Kowalczyk, Jacek, MD, Kowalski, Oskar, MD, Gąsior, Mariusz, MD, Wąs, Tomasz, MD, Zębik, Tadeusz, MD, Krupa, Hubert, MD, Chodór, Piotr, MD, Poloński, Lech, MD, PhD, Zembala, Marian, MD, PhD
Format: Article
Language:English
Subjects:
Angioplasty, Balloon, Coronary
Biological and medical sciences
Cardiology
Cardiology. Vascular system
Cardiovascular
Coronary heart disease
Coronary vessels
Diseases of the cardiovascular system
Female
Heart
Heart attacks
Hospitalization
Humans
Male
Medical sciences
Middle Aged
Mortality
Myocardial Infarction - therapy
Prognosis
Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects)
Time Factors
Treatment Outcome
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Summary: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.
ISSN:0002-8703
1097-6744
DOI:10.1016/j.ahj.2006.10.033