Prevalence, Predictors, and In-Hospital Outcomes of Non-Infarct Artery Intervention During Primary Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction (from the National Cardiovascular Data Registry)

• Published in: The American journal of cardiology Vol. 104; no. 4; pp. 507 - 513
• Main Authors: Cavender, Matthew A., MD, Milford-Beland, Sarah, MS, Roe, Matthew T., MD, MHS, Peterson, Eric D., MD, MPH, Weintraub, William S., MD, Rao, Sunil V., MD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 15-08-2009; Elsevier; Elsevier Limited
• Subjects: Aged; Angioplasty; Angioplasty, Balloon, Coronary; Biological and medical sciences; Cardiology; Cardiology. Vascular system; Cardiovascular; Cardiovascular disease; Clinical outcomes; Coronary Artery Disease - epidemiology; Coronary Artery Disease - physiopathology; Coronary Artery Disease - therapy; Coronary heart disease; Coronary vessels; Diseases of the cardiovascular system; Female; Heart; Hospital Mortality; Humans; Male; Medical sciences; Middle Aged; Mortality; Myocardial Infarction - mortality; Myocardial Infarction - physiopathology; Myocardial Infarction - therapy; Myocarditis. Cardiomyopathies; Prevalence; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Registries; Risk Factors; Studies; Treatment Outcome; United States - epidemiology; United States; Myocardial infarction; Atherectomy; Prognosis; Prevalence; Angioplasty; Predictor; Coronary artery; Instrumentation therapy; Cardiovascular disease; Data; Coronary heart disease; Epidemiology; Myocardial disease; Stent; Percutaneous route; ST elevation; Primary; Circulatory system; Hospital; Cardiology; Predictive factor
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2009.04.016

Guidelines support percutaneous coronary intervention (PCI) of the noninfarct-related artery during primary PCI for ST-segment elevation myocardial infarction (STEMI) in patients with hemodynamic compromise; however, in patients without hemodynamic compromise, PCI of the noninfarct-related artery is given a class III recommendation. We analyzed the National Cardiovascular Data Registry (n = 708,481 admissions, 638 sites) to determine the prevalence, predictors, and in-hospital outcomes of primary multivessel PCI from 2004 to 2007. Patients with STEMI and multivessel coronary artery disease who were undergoing primary PCI were identified (n = 31,681). After excluding the patients treated with staged PCI (n = 2,745), 10.8% (n = 3,134) of the remaining population (n = 28,936) were treated with multivessel PCI. Patients undergoing multivessel PCI were at higher risk and were more likely to be in cardiogenic shock. The overall in-hospital mortality rates were greater in patients undergoing multivessel PCI (7.9% vs 5.1%, p <0.01). Among patients with STEMI and cardiogenic shock (n = 3,087), those receiving multivessel PCI had greater in-hospital mortality (36.5% vs 27.8%; adjusted odds ratio 1.54, 95% confidence interval 1.22 to 1.95). In conclusion, these data suggest that performing multivessel PCI during primary PCI for STEMI does not improve short-term survival even for patients with cardiogenic shock. These findings suggest the need for definitive studies to evaluate the utility of noninfarct-related artery PCI among patients with STEMI.