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. 2011 Dec;41(12):718-25.
doi: 10.4070/kcj.2011.41.12.718. Epub 2011 Dec 31.

Culprit-Lesion-Only Versus Multivessel Revascularization Using Drug-Eluting Stents in Patients With ST-Segment Elevation Myocardial Infarction: A Korean Acute Myocardial Infarction Registry-Based Analysis

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Free PMC article

Culprit-Lesion-Only Versus Multivessel Revascularization Using Drug-Eluting Stents in Patients With ST-Segment Elevation Myocardial Infarction: A Korean Acute Myocardial Infarction Registry-Based Analysis

Hyun Su Jo et al. Korean Circ J. .
Free PMC article

Abstract

Background and objectives: In patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease, complete revascularization (CR) for non-culprit lesions is not routinely recommended. The aim of this study was to compare the clinical outcomes of multivessel compared with infarct-related artery (IRA)-only revascularization in patients undergoing primary percutaneous coronary intervention (PCI) for STEMI.

Subjects and methods: From the Korean Acute Myocardial Infarction Registry (KAMIR) database, 1,094 STEMI patients with multivessel disease who underwent primary PCI with drug-eluting stents were enrolled in this study. The patients were divided into two groups: culprit-vessel-only revascularization (COR, n=827) group; multivessel revascularization, including non-IRA (MVR, n=267) group. The primary endpoint of this study included major adverse cardiac events (MACEs), such as death, myocardial infarction, or target or nontarget lesion revascularization at one year.

Results: There was no difference in clinical characteristics between the two groups. During the one-year follow-up, 102 (15.2%) patients in the COR group and 32 (14.2%) in the MVR group experienced at least one MACE (p=0.330). There were no differences between the two groups in terms of rates of death, myocardial infarction, or revascularization (2.1% vs. 2.0%, 0.7% vs. 0.8%, and 11.7% vs. 10.1%, respectively; p=0.822, 0.910, and 0.301, respectively). The MACE rate was higher in the incompletely revascularized patients than in the completely revascularized patients (15% vs. 9.5%, p=0.039), and the difference was attributable to a higher rate of nontarget vessel revascularization (8.6% vs. 1.8%, p=0.002).

Conclusion: Although multivessel angioplasty during primary PCI for STEMI did not reduce the MACE rate compared with culprit-vessel-only PCI, CR was associated with a lower rate of repeat revascularization after multivessel PCI.

Keywords: Angioplasty; Coronary artery disease; Myocardial infarction.

Conflict of interest statement

The authors have no financial conflicts of interest.

Figures

Fig. 1
Fig. 1
Flowchart of patients who participated in the study. KAMIR: Korean Acute Myocardial Infarction Registry, NSTEMI: non-ST-elevation myocardial infarction, STEMI: ST-elevation myocardial infarction, PCI: percutaneous coronary intervention, BMS: bare-metal stent, CPR: cardiopulmonary resuscitation, BP: blood pressure, DES: drug-eluting stent, COR: culprit-vessel-only revascularization, MVR: multivessel revascularization, CR: complete revascularization, IR: incomplete revascularization.
Fig. 2
Fig. 2
One-year MACE-free survival in the COR and MVR groups. MACE: major adverse cardiac event, COR: culprit-vessel-only revascularization, MVR: multivessel revascularization.
Fig. 3
Fig. 3
A: one-year MACE-free survival in the CR and IR subgroups. B: one-year nontarget vessel percutaneous coronary intervention-free survival in the CR and IR subgroups. MACE: major adverse cardiac event, CR: complete revascularization, IR: Incomplete revascularization.

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