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Prognosis of complete versus incomplete revascularisation of patients with STEMI with multivessel coronary artery disease: an observational study

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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.

No MeSH data available.


Related in: MedlinePlus

Kaplan-Meier curves for the end point all-cause mortality in the total patient population stratified according to complete/incomplete revascularisation. Patients with incomplete revascularisation had a statistically significant higher cumulative incidence of all-cause mortality (p (log-rank)<0.001) during long-term follow-up after ST-segment elevation myocardial infarction in comparison with patients with complete revascularisation.
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Figure 1: Kaplan-Meier curves for the end point all-cause mortality in the total patient population stratified according to complete/incomplete revascularisation. Patients with incomplete revascularisation had a statistically significant higher cumulative incidence of all-cause mortality (p (log-rank)<0.001) during long-term follow-up after ST-segment elevation myocardial infarction in comparison with patients with complete revascularisation.

Mentions: Long-term follow-up was complete in all patients with a median follow-up of 6.7 years (IQR 5.6–7.9 years). Ninety-eight patients died; 67 of them (68%) died after 30 days post-STEMI. The Kaplan-Meier survival curves stratified according to complete versus incomplete revascularisation are presented in figure 1. Patients with STEMI with multi-vessel CAD and incomplete revascularisation showed higher mortality rates compared with patients who received complete revascularisation (24% vs 12%, p<0.001).


Prognosis of complete versus incomplete revascularisation of patients with STEMI with multivessel coronary artery disease: an observational study
Kaplan-Meier curves for the end point all-cause mortality in the total patient population stratified according to complete/incomplete revascularisation. Patients with incomplete revascularisation had a statistically significant higher cumulative incidence of all-cause mortality (p (log-rank)<0.001) during long-term follow-up after ST-segment elevation myocardial infarction in comparison with patients with complete revascularisation.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5384460&req=5

Figure 1: Kaplan-Meier curves for the end point all-cause mortality in the total patient population stratified according to complete/incomplete revascularisation. Patients with incomplete revascularisation had a statistically significant higher cumulative incidence of all-cause mortality (p (log-rank)<0.001) during long-term follow-up after ST-segment elevation myocardial infarction in comparison with patients with complete revascularisation.
Mentions: Long-term follow-up was complete in all patients with a median follow-up of 6.7 years (IQR 5.6–7.9 years). Ninety-eight patients died; 67 of them (68%) died after 30 days post-STEMI. The Kaplan-Meier survival curves stratified according to complete versus incomplete revascularisation are presented in figure 1. Patients with STEMI with multi-vessel CAD and incomplete revascularisation showed higher mortality rates compared with patients who received complete revascularisation (24% vs 12%, p<0.001).

View Article: PubMed Central - PubMed

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 (&ge;70%&thinsp;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&lt;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.

No MeSH data available.


Related in: MedlinePlus