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.
Health Status After Treatment for Coronary Artery Disease and Type 2 Diabetes Mellitus in the Bypass Angioplasty Revascularization Investigation 2 Diabetes Trial
