TY - JOUR
T1 - Non-culprit coronary artery percutaneous coronary intervention during acute ST-segment elevation myocardial infarction
T2 - Insights from the APEX-AMI trial
AU - Toma, Mustafa
AU - Buller, Christopher E.
AU - Westerhout, Cynthia M.
AU - Fu, Yuling
AU - O'Neill, William W.
AU - Holmes, David R.
AU - Hamm, Christian W.
AU - Granger, Christopher B.
AU - Armstrong, Paul W.
N1 - Funding Information:
This work was supported by funding from Procter & Gamble Pharmaceuticals and Alexion Pharmaceuticals.
PY - 2010/7
Y1 - 2010/7
N2 - Aims To examine the incidence of and propensity for non-culprit interventions performed at the time of the primary percutaneous coronary intervention (PCI) and its association with 90-day outcomes.Methods and resultsWe examined the incidence, propensity for, and associated 90-day outcomes following non-culprit interventions performed at the time of primary PCI among ST-elevation myocardial infarction patients with multi-vessel coronary artery disease (MVD). Of the 5373 patients who underwent primary PCI in the APEX-AMI trial, 2201 had MVD. Of those, 217 (9.9) underwent non-infarct-related arteries (IRA) PCI, whereas 1984 (90.1) underwent PCI of the IRA alone. Ninety-day death and death/CHF/shock were higher in the non-IRA group compared with the IRA-only PCI group (12.5 vs. 5.6, P (log-rank) < 0.001 and 17.4 vs. 12.0, P (log-rank) = 0.020, respectively). After adjusting for patient and procedural characteristics as well as propensity for performing non-IRA PCI, this procedure remained independently associated with an increased hazard of 90-day mortality [adjusted hazard ratio 2.44, 95 CI (1.55-3.83), P < 0.001]. Conclusion Non-culprit coronary interventions were performed at the time of primary PCI in 10 of MVD patients and were significantly associated with increased mortality. Our data support current guideline recommendations discouraging the performance of such procedures in stable primary PCI patients. Prospective randomized study of this issue may be warranted.
AB - Aims To examine the incidence of and propensity for non-culprit interventions performed at the time of the primary percutaneous coronary intervention (PCI) and its association with 90-day outcomes.Methods and resultsWe examined the incidence, propensity for, and associated 90-day outcomes following non-culprit interventions performed at the time of primary PCI among ST-elevation myocardial infarction patients with multi-vessel coronary artery disease (MVD). Of the 5373 patients who underwent primary PCI in the APEX-AMI trial, 2201 had MVD. Of those, 217 (9.9) underwent non-infarct-related arteries (IRA) PCI, whereas 1984 (90.1) underwent PCI of the IRA alone. Ninety-day death and death/CHF/shock were higher in the non-IRA group compared with the IRA-only PCI group (12.5 vs. 5.6, P (log-rank) < 0.001 and 17.4 vs. 12.0, P (log-rank) = 0.020, respectively). After adjusting for patient and procedural characteristics as well as propensity for performing non-IRA PCI, this procedure remained independently associated with an increased hazard of 90-day mortality [adjusted hazard ratio 2.44, 95 CI (1.55-3.83), P < 0.001]. Conclusion Non-culprit coronary interventions were performed at the time of primary PCI in 10 of MVD patients and were significantly associated with increased mortality. Our data support current guideline recommendations discouraging the performance of such procedures in stable primary PCI patients. Prospective randomized study of this issue may be warranted.
KW - Myocardial infarction
KW - Non-culprit coronary artery
KW - Primary percutaneous coronary intervention
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U2 - 10.1093/eurheartj/ehq129
DO - 10.1093/eurheartj/ehq129
M3 - Article
C2 - 20530505
AN - SCOPUS:77954777044
SN - 0195-668X
VL - 31
SP - 1701
EP - 1707
JO - European heart journal
JF - European heart journal
IS - 14
ER -