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

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 ra...

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Autores principales: Dimitriu-Leen, Aukelien C, Hermans, Maaike P J, Veltman, Caroline E, van der Hoeven, Bas L, van Rosendael, Alexander R, van Zwet, Erik W, Schalij, Martin J, Delgado, Victoria, Bax, Jeroen J, Scholte, Arthur J H A
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Open Heart 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5384460/
https://www.ncbi.nlm.nih.gov/pubmed/28409009
http://dx.doi.org/10.1136/openhrt-2016-000541
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author Dimitriu-Leen, Aukelien C
Hermans, Maaike P J
Veltman, Caroline E
van der Hoeven, Bas L
van Rosendael, Alexander R
van Zwet, Erik W
Schalij, Martin J
Delgado, Victoria
Bax, Jeroen J
Scholte, Arthur J H A
author_facet Dimitriu-Leen, Aukelien C
Hermans, Maaike P J
Veltman, Caroline E
van der Hoeven, Bas L
van Rosendael, Alexander R
van Zwet, Erik W
Schalij, Martin J
Delgado, Victoria
Bax, Jeroen J
Scholte, Arthur J H A
author_sort Dimitriu-Leen, Aukelien C
collection PubMed
description 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.
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spelling pubmed-53844602017-04-13 Prognosis of complete versus incomplete revascularisation of patients with STEMI with multivessel coronary artery disease: an observational study Dimitriu-Leen, Aukelien C Hermans, Maaike P J Veltman, Caroline E van der Hoeven, Bas L van Rosendael, Alexander R van Zwet, Erik W Schalij, Martin J Delgado, Victoria Bax, Jeroen J Scholte, Arthur J H A Open Heart Interventional Cardiology 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. Open Heart 2017-03-15 /pmc/articles/PMC5384460/ /pubmed/28409009 http://dx.doi.org/10.1136/openhrt-2016-000541 Text en © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted. 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/
spellingShingle Interventional Cardiology
Dimitriu-Leen, Aukelien C
Hermans, Maaike P J
Veltman, Caroline E
van der Hoeven, Bas L
van Rosendael, Alexander R
van Zwet, Erik W
Schalij, Martin J
Delgado, Victoria
Bax, Jeroen J
Scholte, Arthur J H A
Prognosis of complete versus incomplete revascularisation of patients with STEMI with multivessel coronary artery disease: an observational study
title Prognosis of complete versus incomplete revascularisation of patients with STEMI with multivessel coronary artery disease: an observational study
title_full Prognosis of complete versus incomplete revascularisation of patients with STEMI with multivessel coronary artery disease: an observational study
title_fullStr Prognosis of complete versus incomplete revascularisation of patients with STEMI with multivessel coronary artery disease: an observational study
title_full_unstemmed Prognosis of complete versus incomplete revascularisation of patients with STEMI with multivessel coronary artery disease: an observational study
title_short Prognosis of complete versus incomplete revascularisation of patients with STEMI with multivessel coronary artery disease: an observational study
title_sort prognosis of complete versus incomplete revascularisation of patients with stemi with multivessel coronary artery disease: an observational study
topic Interventional Cardiology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5384460/
https://www.ncbi.nlm.nih.gov/pubmed/28409009
http://dx.doi.org/10.1136/openhrt-2016-000541
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