Culprit vessel versus multivessel intervention at the time of primary percutaneous coronary intervention in patients with ST-segment-elevation myocardial infarction and multivessel disease: real-world analysis of 3984 patients in London.
936 - 943
Circ Cardiovasc Qual Outcomes
MetadataShow full item record
BACKGROUND: It is estimated that up to two thirds of patients presenting with ST-segment-elevation myocardial infarction have multivessel disease. The optimal strategy for treating nonculprit disease is currently under debate. This study provides a real-world analysis comparing a strategy of culprit-vessel intervention (CVI) versus multivessel intervention at the time of primary percutaneous coronary intervention in patients with ST-segment-elevation myocardial infarction. METHODS AND RESULTS: We compared CVI versus multivessel intervention in 3984 patients with multivessel disease undergoing primary percutaneous coronary intervention between 2004 and 2011 at all 8 tertiary cardiac centers in London. Multivariable-adjusted models were built to determine independent predictors for in-hospital major adverse cardiovascular events (MACEs) and all-cause mortality at 1 year. To reduce confounding and bias, propensity score methods were used. CVI was associated with reduced in-hospital MACE (4.6% versus 7.2%; P=0.010) and mortality at 1 year (7.4% versus 10.1%; P=0.031). CVI was an independent predictor for reduced in-hospital MACE (odds ratio, 0.49; 95% confidence interval [CI], 0.32-0.75; P<0.001) and survival at 1 year (hazard ratio, 0.65; 95% CI, 0.47-0.91; P=0.011) in the complete cohort; and in 2821 patients in propensity-matched cohort (in-hospital MACE: odds ratio, 0.49; 95% CI, 0.32-0.76; P=0.002; and 1-year survival: hazard ratio, 0.64; 95% CI, 0.45-0.90; P=0.010). Inverse probability treatment weighted analyses also confirmed CVI as an independent predictor for reduced in-hospital MACE (odds ratio, 0.38; 95% CI, 0.15-0.96; P=0.040) and survival at 1 year (hazard ratio, 0.44; 95% CI, 0.21-0.93; P=0.033). CONCLUSIONS: In this observational analysis of patients with ST-segment-elevation myocardial infarction undergoing primary percutaneous coronary intervention, CVI was associated with increased survival at 1 year. Acknowledging the limitations with observational analyses, our findings support current recommended practice guidelines.
AuthorsIqbal, MB; Ilsley, C; Kabir, T; Smith, R; Lane, R; Mason, M; Clifford, P; Crake, T; Firoozi, S; Kalra, S; Knight, C; Lim, P; Malik, IS; Mathur, A; Meier, P; Rakhit, RD; Redwood, S; Whitbread, M; Bromage, D; Rathod, K; MacCarthy, P; Dalby, M; London Heart Attack Centre (HAC) Group Investigators,
- College Publications 
Showing items related by title, author, creator and subject.
Combined analysis of the safety of intra-coronary drug delivery during primary percutaneous coronary intervention for acute myocardial infarction: A study of three clinical trials. Rathod, KS; Hamshere, S; Khambata, RS; Andiapen, M; Westwood, M; Mathur, A; Ahluwalia, A; Jones, DA (Sage journals, 2017-08-16)Background: The local injection of novel cardioprotective study drugs prior to percutaneous coronary intervention could cause embolisation of thrombus, resulting in increased reperfusion injury and subsequent infarct size. ...
Mortality in South Asians and Caucasians after percutaneous coronary intervention in the United Kingdom: an observational cohort study of 279,256 patients from the BCIS (British Cardiovascular Intervention Society) National Database. Jones, DA; Gallagher, S; Rathod, KS; Redwood, S; de Belder, MA; Mathur, A; Timmis, AD; Ludman, PF; Townend, JN; Wragg, A;... (2014-04)OBJECTIVES: The purpose of this study was to compare baseline characteristics and medium-term prognosis in South Asian and Caucasian patients undergoing percutaneous coronary intervention (PCI). BACKGROUND: It is unclear ...
Assessment of a novel biomarker panel for the earlier prediction of acute kidney injury in patients with diabetes mellitus undergoing coronary angiography and intervention Qureshi, Ayesha (2012)Diabetes mellitus triples the risk of developing coronary heart disease (CHD). The manifestations of CHD are more severe in patients with diabetes with both more extensive and more diffuse disease. Outcomes in patients ...