scholarly journals Staged complete revascularization or culprit-only percutaneous coronary intervention for multivessel coronary artery disease in patients with ST-segment elevation myocardial infarction and diabetes

2019 ◽  
Vol 18 (1) ◽  
Author(s):  
Kongyong Cui ◽  
Shuzheng Lyu ◽  
Hong Liu ◽  
Xiantao Song ◽  
Fei Yuan ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Primary Endpoint ◽  
Cardiac Death ◽  
Coronary Intervention ◽  
Multivessel Disease ◽  
Diabetic Patients ◽  
Complete Revascularization ◽  
St Segment Elevation ◽  
St Segment ◽  
Diabetes Status

Abstract Background Recently, several randomized trials have noted improved outcomes with staged percutaneous coronary intervention (PCI) of nonculprit vessels in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease. However, it remains unclear whether diabetes status affects the outcomes after different revascularization strategies. This study thus compared the impact of diabetes status on long-term outcomes after staged complete revascularization with that after culprit-only PCI. Methods From January 2006 to December 2015, 371 diabetic patients (staged PCI: 164, culprit-only PCI: 207) and 834 nondiabetic patients (staged PCI: 412, culprit-only PCI: 422) with STEMI and multivessel disease were enrolled. The primary endpoint was 5-year major adverse cardiac and cerebrovascular event (MACCE), defined as a composite of all-cause death, myocardial infarction (MI), stroke or unplanned revascularization. Results The rate of the 5-year composite primary endpoint for diabetic patients was close to that for nondiabetic patients (34.5% vs. 33.7%; adjusted hazard ratio [HR] 1.012, 95% confidence interval [CI] 0.815–1.255). In nondiabetic patients, the 5-year risks of MACCE (31.8% vs. 35.5%; adjusted HR 0.638, 95% CI 0.500–0.816), MI (4.6% vs. 9.2%; adjusted HR 0.358, 95% CI 0.200–0.641), unplanned revascularization (19.9% vs. 24.9%; adjusted HR 0.532, 95% CI 0.393–0.720), and the composite of cardiac death, MI or stroke (11.4% vs. 15.2%; adjusted HR 0.621, 95% CI 0.419–0.921) were significantly lower after staged PCI than after culprit-only PCI. In contrast, no significant difference was found between the two groups with respect to MACCE, MI, unplanned revascularization, and the composite of cardiac death, MI or stroke in diabetic patients. Significant interactions were found between diabetes status and revascularization assignment for the composite of cardiac death, MI or stroke (Pinteraction = 0.013), MI (Pinteraction = 0.005), and unplanned revascularization (Pinteraction = 0.013) at 5 years. In addition, the interaction tended to be significant for the primary endpoint of MACCE (Pinteraction = 0.053). Moreover, the results of propensity score-matching analysis were concordant with the overall analysis in both diabetic and nondiabetic population. Conclusions In patients with STEMI and multivessel disease, diabetes is not an independent predictor of adverse cardiovascular events at 5 years. In nondiabetic patients, an approach of staged complete revascularization is superior to culprit-only PCI, whereas the advantage of staged PCI is attenuated in diabetic patients. Trial registration This study was not registered in an open access database

scholarly journals Comparative Effectiveness of Complete Revascularization versus Infarct Related Artery-only Percutaneous Coronary Revascularization for Multivessel Disease after ST-Segment Elevation Myocardial Infarction

2016 ◽  
Vol 8 ◽  
Author(s):  
Joshua Chadwick Jayaraj ◽  
Lusine Abrahamyan ◽  
Anahit Demirchyan
Keyword(s):  
Myocardial Infarction ◽  
Primary Endpoint ◽  
Coronary Intervention ◽  
Multivessel Disease ◽  
Index Admission ◽  
Complete Revascularization ◽  
Font Size ◽  
St Segment Elevation ◽  
Percutaneous Coronary ◽  
Infarct Related Artery

<p class="MsoNormal" style="margin-bottom: .0001pt; line-height: 200%; mso-layout-grid-align: none; text-autospace: none;"><strong><span style="font-size: 12.0pt; line-height: 200%; font-family: 'Times New Roman','serif';">Objectives:</span></strong><span style="font-size: 12.0pt; line-height: 200%; font-family: 'Times New Roman','serif';"> The purpose of this study was to evaluate the event free survival from major adverse cardiac events (MACE) for ST-segment elevation myocardial infarction (STEMI) patients with multivessel disease as a function of whether they underwent infarct-related artery (IRA) only percutaneous coronary intervention (PCI) or complete revascularization at index admission.</span></p><p class="MsoNormal" style="margin-bottom: .0001pt; line-height: 200%; mso-layout-grid-align: none; text-autospace: none;"><strong><span style="font-size: 12.0pt; line-height: 200%; font-family: 'Times New Roman','serif';">Background</span></strong><span style="font-size: 12.0pt; line-height: 200%; font-family: 'Times New Roman','serif';">: The optimal management of patients with STEMI and multivessel disease while undergoing primary percutaneous coronary intervention (P-PCI) is uncertain.</span></p><p class="MsoNormal" style="margin-bottom: .0001pt; line-height: 200%; mso-layout-grid-align: none; text-autospace: none;"><strong><span style="font-size: 12.0pt; line-height: 200%; font-family: 'Times New Roman','serif';">Methods and Results: </span></strong><span style="font-size: 12.0pt; line-height: 200%; font-family: 'Times New Roman','serif';">STEMI patients with multivessel disease undergoing P-PCI between April 1, 2012, and March 31, 2014, were subdivided into those who underwent in-hospital complete revascularization (n= 150) or IRA-only revascularization (n = 156). Complete revascularization was performed during the index admission of P-PCI. The primary endpoint was a composite of all-cause death, recurrent myocardial infarction (MI), heart failure, and ischemia-driven revascularization within 24 months. Patient groups were differed at baseline by gender and prevalence of </span><span style="font-size: 12.0pt; line-height: 200%; font-family: 'Times New Roman','serif'; mso-ansi-language: EN-CA;" lang="EN-CA">heart failure</span><span style="font-size: 12.0pt; line-height: 200%; font-family: 'Times New Roman','serif';">. The average door-to-balloon time was significantly higher in the complete revascularization group. The primary endpoint occurred in 11.0% of the complete revascularization group versus 23% in the IRA-only revascularization group (hazard ratio: 0.51; 95% confidence interval: 0.34 to 0.93; p =0.039). There was a significant reduction in death, a non-significant reduction in all primary endpoint components was seen. </span></p><strong><span style="font-size: 12.0pt; line-height: 115%; font-family: 'Times New Roman','serif'; mso-fareast-font-family: 'Times New Roman'; mso-ansi-language: EN-US; mso-fareast-language: EN-US; mso-bidi-language: EN-US;">Conclusions:</span></strong><span style="font-size: 12.0pt; line-height: 115%; font-family: 'Times New Roman','serif'; mso-fareast-font-family: 'Times New Roman'; mso-ansi-language: EN-US; mso-fareast-language: EN-US; mso-bidi-language: EN-US;"> In patients presenting for P-PCI with multivessel disease, index admission complete revascularization significantly lowered the rate of the primary composite endpoint at 24 months compared with treating only the IRA. </span>

scholarly journals Complete Revascularization Versus Culprit Lesion Only in Patients With ST-Segment Elevation Myocardial Infarction and Multivessel Disease

2019 ◽  
Vol 12 (8) ◽  
pp. 721-730 ◽  
Author(s):  
Kasper Kyhl ◽  
Kiril Aleksov Ahtarovski ◽  
Lars Nepper-Christensen ◽  
Kathrine Ekström ◽  
Adam Ali Ghotbi ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Multivessel Disease ◽  
Complete Revascularization ◽  
Culprit Lesion ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment

scholarly journals Complete revascularization reduces cardiovascular death in patients with ST-segment elevation myocardial infarction and multivessel disease: systematic review and meta-analysis of randomized clinical trials

2019 ◽  
Vol 41 (42) ◽  
pp. 4103-4110 ◽  
Author(s):  
Rita Pavasini ◽  
Simone Biscaglia ◽  
Emanuele Barbato ◽  
Matteo Tebaldi ◽  
Dariusz Dudek ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Clinical Trials ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Cardiovascular Death ◽  
Multivessel Disease ◽  
Complete Revascularization ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment

Abstract Aims The aim of this work was to investigate the prognostic impact of revascularization of non-culprit lesions in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease by performing a meta-analysis of available randomized clinical trials (RCTs). Methods and results Data from six RCTs comparing complete vs. culprit-only revascularization in STEMI patients with multivessel disease were analysed with random effect generic inverse variance method meta-analysis. The endpoints were expressed as hazard ratio (HR) with 95% confidence interval (CI). The primary outcome was cardiovascular death. Main secondary outcomes of interest were all-cause death, myocardial infarction (MI), and repeated coronary revascularization. Overall, 6528 patients were included (3139 complete group, 3389 culprit-only group). After a follow-up ranging between 1 and 3 years (median 2 years), cardiovascular death was significantly reduced in the group receiving complete revascularization (HR 0.62, 95% CI 0.39–0.97, I2 = 29%). The number needed to treat to prevent one cardiovascular death was 70 (95% CI 36–150). The secondary endpoints MI and revascularization were also significantly reduced (HR 0.68, 95% CI 0.55–0.84, I2 = 0% and HR 0.29, 95% CI 0.22–0.38, I2 = 36%, respectively). Needed to treats were 45 (95% CI 37–55) for MI and 8 (95% CI 5–13) for revascularization. All-cause death (HR 0.81, 95% CI 0.56–1.16, I2 = 27%) was not affected by the revascularization strategy. Conclusion In a selected study population of STEMI patients with multivessel disease, a complete revascularization strategy is associated with a reduction in cardiovascular death. This reduction is concomitant with that of MI and the need of repeated revascularization.

Interaction of ischaemic postconditioning and thrombectomy in patients with ST-elevation myocardial infarction

Heart ◽  
2019 ◽  
Vol 106 (1) ◽  
pp. 24-32 ◽  
Author(s):  
Lars Nepper-Christensen ◽  
Dan Eik Høfsten ◽  
Steffen Helqvist ◽  
Jens Flensted Lassen ◽  
Hans-Henrik Tilsted ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Primary Endpoint ◽  
Coronary Intervention ◽  
Primary Pci ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Significant Difference ◽  
All Cause Mortality

ObjectiveThe Third Danish Study of Optimal Acute Treatment of Patients with ST-segment Elevation Myocardial Infarction – Ischaemic Postconditioning (DANAMI-3-iPOST) did not show improved clinical outcome in patients with ST-segment elevation myocardial infarction (STEMI) treated with ischaemic postconditioning. However, the use of thrombectomy was frequent and thrombectomy may in itself diminish the effect of ischaemic postconditioning. We evaluated the effect of ischaemic postconditioning in patients included in DANAMI-3-iPOST stratified by the use of thrombectomy.MethodsPatients with STEMI were randomised to conventional primary percutaneous coronary intervention (PCI) or ischaemic postconditioning plus primary PCI. The primary endpoint was a combination of all-cause mortality and hospitalisation for heart failure.ResultsFrom March 2011 until February 2014, 1234 patients were included with a median follow-up period of 35 (interquartile range 28 to 42) months. There was a significant interaction between ischaemic postconditioning and thrombectomy on the primary endpoint (p=0.004). In patients not treated with thrombectomy (n=520), the primary endpoint occurred in 33 patients (10%) who underwent ischaemic postconditioning (n=326) and in 35 patients (18%) who underwent conventional treatment (n=194) (adjusted hazard ratio (HR) 0.55 (95%confidence interval (CI) 0.34 to 0.89), p=0.016). In patients treated with thrombectomy (n=714), there was no significant difference between patients treated with ischaemic postconditioning (n=291) and conventional PCI (n=423) on the primary endpoint (adjusted HR 1.18 (95% CI 0.62 to 2.28), p=0.62).ConclusionsIn this post-hoc study of DANAMI-3-iPOST, ischaemic postconditioning, in addition to primary PCI, was associated with reduced risk of all-cause mortality and hospitalisation for heart failure in patients with STEMI not treated with thrombectomy.Trial registration numberNCT01435408.

scholarly journals Predictive Value of the Acute-to-Chronic Glycemic Ratio for In-Hospital Outcomes in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Percutaneous Coronary Intervention

Angiology ◽  
2019 ◽  
Vol 71 (1) ◽  
pp. 38-47 ◽  
Author(s):  
Side Gao ◽  
Qingbo Liu ◽  
Xiaosong Ding ◽  
Hui Chen ◽  
Xueqiao Zhao ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Predictive Value ◽  
Coronary Intervention ◽  
Diabetic Patients ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
End Point ◽  
St Segment ◽  
Percutaneous Coronary

This study investigated whether a novel index of stress hyperglycemia might have a better prognostic value compared to admission glycemia alone in patients with ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI). The acute-to-chronic glycemic ratio was expressed as admission blood glucose (ABG) devided by the estimated average glucose (eAG), and eAG was derived from the glycated hemoglobin (HbA1c). A total of 1300 consecutive patients with STEMI treated with PCI were included. Baseline data and outcomes were analyzed. The study end point was a composite of in-hospital all-cause death, cardiogenic shock, and acute pulmonary edema. Accuracy was defined with area under the curve (AUC) by a receiver–operating characteristic (ROC) curve analysis. After multivariate adjustment, both ABG/eAG and ABG were closely associated with an increased risk of the composite end point in nondiabetic patients. However, only ABG/eAG (odds ratio = 2.45, 95% confidence interval: 1.24-4.82, P = .010), instead of ABG, was associated with the outcomes in diabetic patients. Compared to ABG, ABG/eAG had an equivalent predictive value in nondiabetic patients but a superior discriminatory ability in diabetic patients (AUC improved from 0.52-0.63, P < .001). Taken together, ABG/eAG provides more significant in-hospital prognostic information than ABG in diabetic patients with STEMI after PCI.

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