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Complete Revascularization and Survival in STEMI

BACKGROUND: Complete revascularization (CR) of ST-elevation myocardial infarction patients with multivessel coronary artery disease (MVD) has proven better regarding combined endpoints than incomplete revascularization (IR) in recent randomized control trials with no impact on survival. OBJECTIVE: T...

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Autores principales: Sustersic, Miha, Mrak, Miha, Svegl, Polona, Kodre, Anamarija Rebolj, Kranjec, Igor, Fras, Zlatko, Bunc, Matjaz
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Ubiquity Press 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8485869/
https://www.ncbi.nlm.nih.gov/pubmed/34692389
http://dx.doi.org/10.5334/gh.1040
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author Sustersic, Miha
Mrak, Miha
Svegl, Polona
Kodre, Anamarija Rebolj
Kranjec, Igor
Fras, Zlatko
Bunc, Matjaz
author_facet Sustersic, Miha
Mrak, Miha
Svegl, Polona
Kodre, Anamarija Rebolj
Kranjec, Igor
Fras, Zlatko
Bunc, Matjaz
author_sort Sustersic, Miha
collection PubMed
description BACKGROUND: Complete revascularization (CR) of ST-elevation myocardial infarction patients with multivessel coronary artery disease (MVD) has proven better regarding combined endpoints than incomplete revascularization (IR) in recent randomized control trials with no impact on survival. OBJECTIVE: To retrospectively evaluate the impact of complete CR during the index hospitalization on survival in STEMI patients with MVD. METHODS AND RESULTS: We included all patients with MVD who underwent successful primary percutaneous coronary intervention for STEMI during their index hospitalization at the University Medical Centre Ljubljana, Slovenia (from 1 January 2009 to 3 April 2011). Coronary angiograms were reviewed for non-culprit coronary arteries (>2 mm in diameter and ≥50% stenosis) treated with percutaneous coronary intervention. Rates of all-cause and cardiovascular death were compared between 235 patients who underwent CR (N = 70) or IR (N = 165). After a median follow-up of 7.0 years (interquartile range 6.0–8.2) the CR group had lower rates of all-cause death (15.7% vs 35.8%, log-rank p = 0.003) and cardiovascular death (12.9% vs 23.6%, log-rank p = 0.046). Multivariable analysis with adjustment for confounders showed no benefit of CR for all-cause death (hazard ratio [HR] 0.60, 95% confidence interval [CI] 0.31–1.18, p = 0.139) or cardiovascular death (HR 0.80, 95% CI 0.37–1.72, p = 0.560). Age, elevated serum creatinine at inclusion, diabetes and cardiogenic shock at presentation were predictors of death. CONCLUSIONS: Patients with STEMI and MVD who underwent CR showed lower all-cause and cardiovascular death during follow-up than those who underwent IR. However, after adjustment for confounders, the real determinates of survival were independent of the revascularization method.
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spelling pubmed-84858692021-10-21 Complete Revascularization and Survival in STEMI Sustersic, Miha Mrak, Miha Svegl, Polona Kodre, Anamarija Rebolj Kranjec, Igor Fras, Zlatko Bunc, Matjaz Glob Heart Original Research BACKGROUND: Complete revascularization (CR) of ST-elevation myocardial infarction patients with multivessel coronary artery disease (MVD) has proven better regarding combined endpoints than incomplete revascularization (IR) in recent randomized control trials with no impact on survival. OBJECTIVE: To retrospectively evaluate the impact of complete CR during the index hospitalization on survival in STEMI patients with MVD. METHODS AND RESULTS: We included all patients with MVD who underwent successful primary percutaneous coronary intervention for STEMI during their index hospitalization at the University Medical Centre Ljubljana, Slovenia (from 1 January 2009 to 3 April 2011). Coronary angiograms were reviewed for non-culprit coronary arteries (>2 mm in diameter and ≥50% stenosis) treated with percutaneous coronary intervention. Rates of all-cause and cardiovascular death were compared between 235 patients who underwent CR (N = 70) or IR (N = 165). After a median follow-up of 7.0 years (interquartile range 6.0–8.2) the CR group had lower rates of all-cause death (15.7% vs 35.8%, log-rank p = 0.003) and cardiovascular death (12.9% vs 23.6%, log-rank p = 0.046). Multivariable analysis with adjustment for confounders showed no benefit of CR for all-cause death (hazard ratio [HR] 0.60, 95% confidence interval [CI] 0.31–1.18, p = 0.139) or cardiovascular death (HR 0.80, 95% CI 0.37–1.72, p = 0.560). Age, elevated serum creatinine at inclusion, diabetes and cardiogenic shock at presentation were predictors of death. CONCLUSIONS: Patients with STEMI and MVD who underwent CR showed lower all-cause and cardiovascular death during follow-up than those who underwent IR. However, after adjustment for confounders, the real determinates of survival were independent of the revascularization method. Ubiquity Press 2021-09-29 /pmc/articles/PMC8485869/ /pubmed/34692389 http://dx.doi.org/10.5334/gh.1040 Text en Copyright: © 2021 The Author(s) https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC-BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. See http://creativecommons.org/licenses/by/4.0/.
spellingShingle Original Research
Sustersic, Miha
Mrak, Miha
Svegl, Polona
Kodre, Anamarija Rebolj
Kranjec, Igor
Fras, Zlatko
Bunc, Matjaz
Complete Revascularization and Survival in STEMI
title Complete Revascularization and Survival in STEMI
title_full Complete Revascularization and Survival in STEMI
title_fullStr Complete Revascularization and Survival in STEMI
title_full_unstemmed Complete Revascularization and Survival in STEMI
title_short Complete Revascularization and Survival in STEMI
title_sort complete revascularization and survival in stemi
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8485869/
https://www.ncbi.nlm.nih.gov/pubmed/34692389
http://dx.doi.org/10.5334/gh.1040
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