Multivessel approach in ST-elevation myocardial infarction: impact on in-hospital morbidity and mortality

Rev Port Cardiol. 2014 Feb;33(2):67-73. doi: 10.1016/j.repc.2013.07.015. Epub 2014 Feb 4.
[Article in English, Portuguese]

Abstract

Introduction: Multivessel disease in ST-elevation myocardial infarction (STEMI) is associated with a worse prognosis. A multivessel approach at the time of primary percutaneous coronary intervention (PCI) is the subject of debate.

Objective: To assess the impact of a multivessel approach on in-hospital morbidity and mortality in patients with STEMI undergoing primary PCI.

Methods: We studied patients from the Portuguese Registry of Acute Coronary Syndromes with STEMI and multivessel disease who underwent primary PCI. The 257 patients were divided into two groups: those who underwent PCI of the culprit artery only and those who underwent multivessel PCI. Cardiovascular risk factors, STEMI location, in-hospital treatment, number and type of diseased and treated arteries, type of stent implanted and ejection fraction were recorded. The primary end-point was defined as in-hospital mortality and the secondary end-point as the presence of at least one of the following complications: major bleeding, need for transfusion, invasive ventilation, heart failure and reinfarction.

Results: Multivessel disease was found in 43.3% of the study population and a multivessel approach was adopted in 19.2% of these patients. There were no differences between the groups in cardiovascular risk factors or electrocardiographic presentation of STEMI. Patients undergoing multivessel PCI were more likely to be treated with drug-eluting stents and glycoprotein IIb/IIIa inhibitors, and less likely to receive heparin therapy. There were no differences between the groups with regard to in-hospital mortality or the incidence of complications.

Conclusion: In our population of patients with STEMI, a multivessel approach appears to be safe and not associated with increased in-hospital mortality or morbidity.

Keywords: Acute myocardial infarction; Angioplastia primária; Doença multivaso; Enfarte agudo do miocárdio; Multivessel disease; Primary percutaneous coronary intervention; Prognosis; Prognóstico.

Publication types

  • Evaluation Study

MeSH terms

  • Aged
  • Coronary Artery Disease / complications
  • Electrocardiography
  • Female
  • Hospital Mortality*
  • Humans
  • Male
  • Middle Aged
  • Myocardial Infarction / complications
  • Myocardial Infarction / etiology
  • Myocardial Infarction / mortality
  • Myocardial Infarction / physiopathology
  • Myocardial Infarction / surgery*
  • Percutaneous Coronary Intervention*