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Immediate multivessel intervention versus culprit-vessel intervention only in patients with ST-elevation myocardial infarction and multivessel coronary disease

data from the prospective KAMIR-NIH registry

Ahn, Sung Gyuna,*; Lee, Jun-Wona,*; Kang, Dae Ryongb; Kim, Hye Simb; Go, Tae-Hwab; Yu, Min Heuib; Kim, Ju Hanc; Jung, Myung Hoc; Park, Jong-Seond; Chae, Shung Chulle; Cho, Myeng-Chang; Kim, Chong Jinh; Gwon, Hyeon-Cheoli; Kim, Hyo-Sooj; Seung, Ki Baek; Cha, Kwang Soom; Chae, Jei Keono; Joo, Seung Jaep; Rha, Seung Woonl; Choi, Dong-Juq; Hur, Seung Hof; Seong, In Whanr; Kim, Doo Iln; Oh, Seok Kyus; Ahn, Tae Hoont; Hwang, Jin Yongu; Yoon, Junghana on behalf of the KAMIR-NIH registry investigators

doi: 10.1097/MCA.0000000000000684
Myocardial Infarction/STEMI

Background The safety and efficacy of immediate multivessel coronary intervention (MVI) remain controversial in patients with ST-elevation myocardial infarction (STEMI) and multivessel disease (MVD). This study aimed to investigate the clinical outcomes of immediate MVI compared with culprit-vessel intervention only (CVI-O) in diverse subgroups with STEMI and MVD.

Patients and methods We compared immediate MVI (n=260) and CVI-O (n=931) regarding 1-year major adverse cardiac event rates for cardiac death, recurrent myocardial infarction (MI), and repeat revascularization in 1191 STEMI patients with MVD using data from the Korea Acute Myocardial Infarction-National Institutes of Health registry (2011–2015). High-risk patients and those who underwent a staged procedure were excluded from the analysis. Furthermore, propensity score matching and stratified subgroup analyses were performed.

Results Immediate MVI and CVI-O groups had similar 1-year major adverse cardiac event rates [7.7 vs. 8.9%, hazard ratio (HR): 0.86, 95% confidence interval (CI): 0.50–1.47, log-rank P=0.5628]. No difference was found between the groups in terms of the 1-year rate of cardiac death (2.9 vs. 1.3%, HR: 2.24, 95% CI: 0.75–6.67) or recurrent MI (2 vs. 1.5%, HR: 1.41, 95% CI: 0.45–4.44). However, repeat revascularization occurred less frequently in the immediate MVI group than in the CVI-O group (2.0 vs. 5.7%, HR: 0.35, 95% CI: 0.13–0.90, log-rank P=0.0142). These findings were found to be consistent across a broad spectrum of subgroups.

Conclusion Compared with CVI-O, immediate MVI did not improve 1-year net clinical outcomes in stable STEMI patients with MVD. The only benefit found was a reduced repeat revascularization in immediate MVI.

aDepartment of Internal Medicine, Division of Cardiology, Wonju Severance Christian Hospital

bCenter of Biomedical Data Science, Yonsei University Wonju College of Medicine, Wonju

cDepartment of Internal Medicine and Heart Center, Chonnam National University Hospital, Gwangju

dDepartment of Internal Medicine, Division of Cardiology, Yeungnam University Medical Center, Yeungnam University College of Medicine

eDepartment of Internal Medicine, Kyungpook National University Hospital, Kyungpook National University, School of Medicine

fDepartment of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu

gDepartment of Internal Medicine, College of Medicine, Chungbuk National University, Cheongju

hDepartment of Internal Medicine, Kyunghee University Hospital at Gandong

iSungkyunkwan University School of Medicine, Samsung Medical Center, Heart Vascular and Stroke Institute

jDepartment of Internal Medicine, Cardiovascular Center, Seoul National University Hospital

kThe Catholic University of Korea

lCardiovascular Center, Korea University Guro Hospital, Seoul

mDepartment of Internal Medicine, Pusan National University Hospital, Busan

nDepartment of Internal Medicine, Inje University College of Medicine, Haeundae Paik Hospital

oDepartment of Internal Medicine, Chunbuk National University School of Medicine, Division of Cardiology, Jeonju

pDepartment of Internal Medicine, Jeju National University Hospital, Jeju, Republic of Korea

qDepartment of Internal Medicine, Seoul National University Bundang Hospital, Seongnam

rDepartment of Internal Medicine, College of Medicine, Chungnam National University Hospital, Chungnam National University, Daejeon

sDepartment of Internal Medicine, Wonkwang University School of Medicine, Division of Cardiology, Iksan

tDepartment of Cardiology, Gil Medical Center, Gachon University College of Medicine, Incheon

uDepartment of Internal Medicine, Gyungsang National University School of Medicine, Gyungsang National University Hospital, Jinju, Republic of Korea

*Sung Gyun Ahn and Jun-Won Lee contributed equally to the writing of this article.

Correspondence to Junghan Yoon, MD, PhD, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Division of Cardiology, 20 Ilsan-ro, Wonju-si 26426, Republic of Korea Tel: +82 337 410 917; fax: +82 337 411 219; e-mail: jyoon@yonsei.ac.kr

Received September 9, 2018

Received in revised form October 20, 2018

Accepted November 13, 2018

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