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Complete Revascularization of Multivessel Coronary Artery Disease Does Not Improve Clinical Outcome in ST-Segment Elevation Myocardial Infarction Patients with Reduced Left Ventricular Ejection Fraction

The benefit of complete revascularization (CR) in ST-segment elevation myocardial infarction (STEMI) patients with left ventricular (LV) dysfunction is uncertain. A total of 1314 STEMI patients with multivessel coronary artery disease were analyzed. CR was defined angiographically and by a residual...

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Autores principales: Kang, Jeehoon, Zheng, Chengbin, Park, Kyung Woo, Park, Jiesuck, Rhee, Taemin, Lee, Hak Seung, Han, Jung-Kyu, Yang, Han-Mo, Kang, Hyun-Jae, Koo, Bon-Kwon, Kim, Hyo-Soo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7019798/
https://www.ncbi.nlm.nih.gov/pubmed/31952345
http://dx.doi.org/10.3390/jcm9010232
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author Kang, Jeehoon
Zheng, Chengbin
Park, Kyung Woo
Park, Jiesuck
Rhee, Taemin
Lee, Hak Seung
Han, Jung-Kyu
Yang, Han-Mo
Kang, Hyun-Jae
Koo, Bon-Kwon
Kim, Hyo-Soo
author_facet Kang, Jeehoon
Zheng, Chengbin
Park, Kyung Woo
Park, Jiesuck
Rhee, Taemin
Lee, Hak Seung
Han, Jung-Kyu
Yang, Han-Mo
Kang, Hyun-Jae
Koo, Bon-Kwon
Kim, Hyo-Soo
author_sort Kang, Jeehoon
collection PubMed
description The benefit of complete revascularization (CR) in ST-segment elevation myocardial infarction (STEMI) patients with left ventricular (LV) dysfunction is uncertain. A total of 1314 STEMI patients with multivessel coronary artery disease were analyzed. CR was defined angiographically and by a residual Synergy between PCI with Taxus and Cardiac Surgery trial (SYNTAX) score (SS) <8. Patients with a left ventricular ejection fraction (LVEF) <40% were classified as the reduced LVEF group. The major study endpoints were patient-oriented composite outcome (POCO) and cardiac death during three-year follow-up. Overall, patients that received angiographic CR (579 patients, 44.1%) had significantly lower three-year clinical events compared with incomplete revascularization (iCR). CR reduced three-year POCO and cardiac death rates in the preserved LVEF group (POCO: 13.2% vs. 21.9%, p < 0.001, cardiac death: 1.8% vs. 6.5%, p < 0.001, respectively) but not in the reduced LVEF group (POCO: 26.0% vs. 33.1%, p = 0.275, cardiac death: 15.1% vs. 19.0%, p = 0.498, respectively). Multivariate analysis showed that CR significantly reduced three-year POCO (hazard ration (HR) 0.59, 95% confidence interval (CI) 0.43–0.82) and cardiac death (HR 0.34, 95% CI 0.14–0.80), only in the preserved LVEF group. Additionally, the results were corroborated using the SS-based CR definition. In STEMI patients with multivessel disease, CR did not improve clinical outcomes in those with reduced LVEF.
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spelling pubmed-70197982020-03-09 Complete Revascularization of Multivessel Coronary Artery Disease Does Not Improve Clinical Outcome in ST-Segment Elevation Myocardial Infarction Patients with Reduced Left Ventricular Ejection Fraction Kang, Jeehoon Zheng, Chengbin Park, Kyung Woo Park, Jiesuck Rhee, Taemin Lee, Hak Seung Han, Jung-Kyu Yang, Han-Mo Kang, Hyun-Jae Koo, Bon-Kwon Kim, Hyo-Soo J Clin Med Article The benefit of complete revascularization (CR) in ST-segment elevation myocardial infarction (STEMI) patients with left ventricular (LV) dysfunction is uncertain. A total of 1314 STEMI patients with multivessel coronary artery disease were analyzed. CR was defined angiographically and by a residual Synergy between PCI with Taxus and Cardiac Surgery trial (SYNTAX) score (SS) <8. Patients with a left ventricular ejection fraction (LVEF) <40% were classified as the reduced LVEF group. The major study endpoints were patient-oriented composite outcome (POCO) and cardiac death during three-year follow-up. Overall, patients that received angiographic CR (579 patients, 44.1%) had significantly lower three-year clinical events compared with incomplete revascularization (iCR). CR reduced three-year POCO and cardiac death rates in the preserved LVEF group (POCO: 13.2% vs. 21.9%, p < 0.001, cardiac death: 1.8% vs. 6.5%, p < 0.001, respectively) but not in the reduced LVEF group (POCO: 26.0% vs. 33.1%, p = 0.275, cardiac death: 15.1% vs. 19.0%, p = 0.498, respectively). Multivariate analysis showed that CR significantly reduced three-year POCO (hazard ration (HR) 0.59, 95% confidence interval (CI) 0.43–0.82) and cardiac death (HR 0.34, 95% CI 0.14–0.80), only in the preserved LVEF group. Additionally, the results were corroborated using the SS-based CR definition. In STEMI patients with multivessel disease, CR did not improve clinical outcomes in those with reduced LVEF. MDPI 2020-01-15 /pmc/articles/PMC7019798/ /pubmed/31952345 http://dx.doi.org/10.3390/jcm9010232 Text en © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Kang, Jeehoon
Zheng, Chengbin
Park, Kyung Woo
Park, Jiesuck
Rhee, Taemin
Lee, Hak Seung
Han, Jung-Kyu
Yang, Han-Mo
Kang, Hyun-Jae
Koo, Bon-Kwon
Kim, Hyo-Soo
Complete Revascularization of Multivessel Coronary Artery Disease Does Not Improve Clinical Outcome in ST-Segment Elevation Myocardial Infarction Patients with Reduced Left Ventricular Ejection Fraction
title Complete Revascularization of Multivessel Coronary Artery Disease Does Not Improve Clinical Outcome in ST-Segment Elevation Myocardial Infarction Patients with Reduced Left Ventricular Ejection Fraction
title_full Complete Revascularization of Multivessel Coronary Artery Disease Does Not Improve Clinical Outcome in ST-Segment Elevation Myocardial Infarction Patients with Reduced Left Ventricular Ejection Fraction
title_fullStr Complete Revascularization of Multivessel Coronary Artery Disease Does Not Improve Clinical Outcome in ST-Segment Elevation Myocardial Infarction Patients with Reduced Left Ventricular Ejection Fraction
title_full_unstemmed Complete Revascularization of Multivessel Coronary Artery Disease Does Not Improve Clinical Outcome in ST-Segment Elevation Myocardial Infarction Patients with Reduced Left Ventricular Ejection Fraction
title_short Complete Revascularization of Multivessel Coronary Artery Disease Does Not Improve Clinical Outcome in ST-Segment Elevation Myocardial Infarction Patients with Reduced Left Ventricular Ejection Fraction
title_sort complete revascularization of multivessel coronary artery disease does not improve clinical outcome in st-segment elevation myocardial infarction patients with reduced left ventricular ejection fraction
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7019798/
https://www.ncbi.nlm.nih.gov/pubmed/31952345
http://dx.doi.org/10.3390/jcm9010232
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