The Official Journal of EuroPCR and the European Association of Percutaneous Coronary Interventions (EAPCI)

Coronary interventions

Multivessel percutaneous coronary intervention in patients with acute myocardial infarction and severe renal dysfunction

EuroIntervention 2019;15:e1014-e1021. DOI: 10.4244/EIJ-D-19-00034

1. Division of Cardiology, Heart Stroke Vascular Center, Mediplex Sejong General Hospital, Incheon, Republic of Korea; 2. Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; 3. Cardiovascular Center, Anam Hospital, Korea University Medical Center, Seoul, Republic of Korea; 4. Cardiovascular Center, Korea University Guro Hospital, Seoul, Republic of Korea; 5. Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea; 6. Chonnam National University Hospital, Gwangju, Republic of Korea

Aims: The aim of this study was to compare the outcomes between multivessel and infarct-related artery (IRA)-only percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI), multivessel disease (MVD), and severe renal dysfunction (RD) using the nationwide AMI registry.

Methods and results: Among 13,104 patients, 537 diagnosed with AMI and MVD who had severe RD at presentation (estimated glomerular filtration rate [GFR] <30 mL/min/1.73 m2, mean: 19.1±7.5 mL/min/1.73 m2) and underwent PCI during index hospitalisation were selected. The patients were classified according to treatment strategy, i.e., multivessel PCI (49.0%) or IRA-only PCI. The primary endpoint was major adverse cardiac events (MACE), a composite of all-cause death, myocardial reinfarction, re-hospitalisation for heart failure, and any repeat revascularisation at one year. The safety outcome was the worsening of renal function (WRF), defined as a 30% reduction in estimated GFR from baseline to 12-month follow-up. The adjusted MACE risks were similar in groups after Cox regression (41.8% vs 39.8%, hazard ratio [HR] 1.008 [0.743-1.367]) and propensity score-matching analysis (HR 0.974 [0.651-1.377]). Multivessel PCI showed a significant tendency of higher rates of WRF (24.8% vs 11.1%, adjusted odds ratio 2.134 [0.976-4.668]).

Conclusions: Multivessel PCI was associated with similar outcomes compared to IRA-only PCI in patients with AMI, MVD, and severe RD.

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