scholarly journals Complete revascularization optimizes patient outcomes in multivessel coronary artery disease: Data from the e‐Ultimaster registry

2021 ◽  
Author(s):  
Timothy Williams ◽  
Aaina Mittal ◽  
Dimitar Karageorgiev ◽  
Andres Iniguez Romo ◽  
Adel Aminian ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Patient Outcomes ◽  
Complete Revascularization ◽  
Multivessel Coronary Artery Disease ◽  
Artery Disease

Abstract P328: Complete vs. ‘Culprit’ Only Revascularization in STEMI Patients With Multivessel Coronary Artery Disease: Practice Patterns, Predictors of Complete Revascularization and Impact on Health Status Outcomes

2011 ◽  
Vol 4 (suppl_1) ◽  
Author(s):  
Amit P Amin ◽  
Adam Salisbury ◽  
Fengming Tang ◽  
Kimberly Reid ◽  
Edward McNulty ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Health Status ◽  
Coronary Artery ◽  
Complete Revascularization ◽  
Multivessel Coronary Artery Disease ◽  
Patient Centered ◽  
St Segment Elevation ◽  
Point Increase ◽  
Artery Disease ◽  
Independent Association

BACKGROUND One third of patients presenting with acute ST segment elevation myocardial infarction (STEMI) are found to have multivessel coronary artery disease (MVD). Several studies have described clinical outcomes after culprit only compared to complete revascularization. Little is known about the health status benefits of these competing strategies. METHODS The 26-center TRIUMPH registry was used to identify STEMI pts with MVD. CR was defined as revascularization of all significant coronary stenoses ≥70%. Numerous demographic and clinical factors were tested for their independent association with CR using multivariable, hierarchical Poisson regression models. The association of CR with 1-year mortality, and disease-specific and generic health status as assessed by the Seattle Angina Questionnaire (SAQ) and SF-12 Physical Component Scores (SF-12 PCS) were evaluated using hierarchical multivariable models. RESULTS Among the 664 STEMI pts with MVD (mean age 58 yrs, 74% male, 25% diabetic, 2.4 ± 0.7 mean diseased vessels), 231 (35%) underwent CR and 433 (65%) had ‘culprit’ revascularization. Among CR pts, 28 (12.1%) had CABG. Of the CR patients treated with PCI 71 (30.7%) occurred concurrent with primary reperfusion while the remainder were staged. Independent predictors of CR included greater number of diseased vessels (RR 1.33, 95% CI 1.17-1.51), LAD culprit (RR 0.63, 95% CI 0.48-0.81), and acute heart failure (RR 1.65, 95% CI 1.10-2.48). An inverse-U shaped relationship between age and CR was present, with pts age 50 most likely and young and old less likely to receive CR. At 1 year, CR was not associated with mortality [2.6% vs. 3.2%, p=0.66) and angina [30.6% vs. 25.9%, p=0.278], but was associated with improved health status - a 4.7 point increase in SAQ quality of life score (95%CI 0.53 - 8.84, p=0.03) and a trend in SF-12 PCS score (2 point increase, 95% CI 0.19 - 4.24, p=0.07). CONCLUSION CR during the index hospitalization for STEMI is common. While CR was not associated with improved 1 year survival, it was associated with improved health status. These patient centered benefits should be considered in future guidelines recommendations.

scholarly journals Effect of Complete Revascularization on 10-Year Survival of Patients With Stable Multivessel Coronary Artery Disease: MASS II Trial

Circulation ◽  
2012 ◽  
Vol 126 (11_suppl_1) ◽  
pp. S158-S163 ◽  
Author(s):  
R. D. Vieira ◽  
W. Hueb ◽  
B. J. Gersh ◽  
E. G. Lima ◽  
A. C. Pereira ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Complete Revascularization ◽  
Multivessel Coronary Artery Disease ◽  
Artery Disease

scholarly journals Impact of complete revascularization for acute myocardial infarction with multivessel coronary artery disease in diabetes mellitus patients

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J Kang ◽  
K.W Park ◽  
T.M Rhee ◽  
H.S Lee ◽  
Y.J Ki ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Acute Myocardial Infarction ◽  
Coronary Artery ◽  
Clinical Outcomes ◽  
Multivessel Disease ◽  
Complete Revascularization ◽  
Multivessel Coronary Artery Disease ◽  
Artery Disease

Abstract Background Clinical benefits of complete revascularization (CR) in acute myocardial infarction (AMI) patients are unclear. Moreover, the benefit of CR is unknown in AMI with Diabetes Mellitus (DM) patient. Objectives We sought to compare prognosis of CR and incomplete revascularization (IR) in patients with AMI and multivessel disease, according to the presence of DM. Methods A total of 2,150 AMI patients with multivessel coronary artery disease were analyzed. CR was defined based on angiographic image. The primary endpoints of this study was patient oriented composite outcome (POCO) defined as a composite of all cause death, any myocardial infarction, and any revascularization within 3 years. Results Overall, 3-year POCO were significantly lower in patients receiving angiographic CR (985 patients, 45.8%) compared with IR (1165 patients, 54.2%). When divided into subgroups according to the presence of DM, CR reduced 3-year clinical outcomes in the non-DM group but not in the DM group (POCO: 11.7% vs. 23.2%, p<0.001, any revascularization: 7.2% vs. 10.8%, p=0.024 in the non-DM group, POCO: 24.3% vs. 27.8%, p=0.295, any revascularization: 13.3% vs. 11.3%, p=0.448 in the DM group, for CR vs. IR). Multivariate analysis showed that CR significantly reduced 3-year POCO (HR 0.52, 95% CI 0.38–0.71) only in the non-DM group. Conclusion In AMI patients with multivessel disease, CR may be ineffective in improving clinical outcomes in patients with DM. Funding Acknowledgement Type of funding source: None

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