dc.contributor.author | Rathod, KS | en_US |
dc.contributor.author | Koganti, S | en_US |
dc.contributor.author | Jain, AK | en_US |
dc.contributor.author | Astroulakis, Z | en_US |
dc.contributor.author | Lim, P | en_US |
dc.contributor.author | Rakhit, R | en_US |
dc.contributor.author | Kalra, SS | en_US |
dc.contributor.author | Dalby, MC | en_US |
dc.contributor.author | O'Mahony, C | en_US |
dc.contributor.author | Malik, IS | en_US |
dc.contributor.author | Knight, CJ | en_US |
dc.contributor.author | Mathur, A | en_US |
dc.contributor.author | Redwood, S | en_US |
dc.contributor.author | Sirker, A | en_US |
dc.contributor.author | MacCarthy, PA | en_US |
dc.contributor.author | Smith, EJ | en_US |
dc.contributor.author | Wragg, A | en_US |
dc.contributor.author | Jones, DA | en_US |
dc.date.accessioned | 2018-10-30T15:49:04Z | |
dc.date.available | 2018-07-30 | en_US |
dc.date.issued | 2018-10-23 | en_US |
dc.date.submitted | 2018-10-26T11:10:35.940Z | |
dc.identifier.other | 10.1016/j.jacc.2018.07.089 | |
dc.identifier.uri | http://qmro.qmul.ac.uk/xmlui/handle/123456789/49369 | |
dc.description.abstract | BACKGROUND: A large proportion of patients presenting with non-ST-segment elevation myocardial infarction (NSTEMI) present with multivessel disease (MVD). There is uncertainty in the role of complete coronary revascularization in this group of patients. OBJECTIVES: The aim of this study was to investigate the outcomes of complete revascularization compared with culprit vessel-only intervention in a large contemporary cohort of patients undergoing percutaneous coronary intervention (PCI) for NSTEMI. METHODS: The authors undertook an observational cohort study of 37,491 NSTEMI patients treated between 2005 and 2015 at the 8 heart attack centers in London. Clinical details were recorded at the time of the procedure into local databases using the British Cardiac Intervention Society (BCIS) PCI dataset. A total of 21,857 patients (58.3%) presented with NSTEMI and MVD. Primary outcome was all-cause mortality at a median follow-up of 4.1 years (interquartile range: 2.2 to 5.8 years). RESULTS: A total of 11,737 (53.7%) patients underwent single-stage complete revascularization during PCI for NSTEMI, rates that significantly increased during the study period (p = 0.006). Those patients undergoing complete revascularization were older and more likely to be male, diabetic, have renal disease and a history of previous myocardial infarction/revascularization compared with the culprit-only revascularization group. Although crude, in-hospital major adverse cardiac event rates were similar (5.2% vs. 4.8%; p = 0.462) between the 2 groups. Kaplan-Meier analysis demonstrated significant differences in mortality rates between the 2 groups (22.5% complete revascularization vs. 25.9% culprit vessel intervention; p = 0.0005) during the follow-up period. After multivariate Cox analysis (hazard ratio: 0.90; 95% confidence interval: 0.85 to 0.97) and the use of propensity matching (hazard ratio: 0.89; 95% confidence interval: 0.76 to 0.98) complete revascularization was associated with reduced mortality. CONCLUSIONS: In NSTEMI patients with MVD, despite higher initial (in-hospital) mortality rates, single-stage complete coronary revascularization appears to be superior to culprit-only vessel PCI in terms of long-term mortality rates. This supports the need for further randomized study to confirm these findings. | en_US |
dc.description.sponsorship | Dr. Dalby has received research grants from Abbott Vascular, Daiichi-Sankyo/Lily, and Sanofi; and has been a consultant for AstraZeneca, Eli Lilly, Medtronic, Edwards Lifesciences, and Boston Scientific. Dr. Smith has received speakers fees/honoraria from Boston Scientific, Abbott Vascular, Vascular Perspectives, and Biosensors International | en_US |
dc.format.extent | 1989 - 1999 | en_US |
dc.language | eng | en_US |
dc.language.iso | en_US | en_US |
dc.relation.ispartof | Journal of the American College of Cardiology | en_US |
dc.rights | © 2018. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/ | |
dc.subject | NSTEMI | en_US |
dc.subject | PCI | en_US |
dc.subject | multivessel intervention | en_US |
dc.subject | myocardial infarction | en_US |
dc.title | Complete Versus Culprit-Only Lesion Intervention in Patients With Acute Coronary Syndromes. | en_US |
dc.type | Article | |
dc.identifier.doi | 10.1016/j.jacc.2018.07.089 | en_US |
pubs.author-url | https://www.ncbi.nlm.nih.gov/pubmed/30336821 | en_US |
pubs.issue | 17 | en_US |
pubs.notes | Not known | en_US |
pubs.publication-status | Published | en_US |
pubs.volume | 72 | en_US |
dcterms.dateAccepted | 2018-07-30 | en_US |