Multivessel percutaneous coronary intervention in patients with acute myocardial infarction and severe renal dysfunction
EuroIntervention 2019, just accepted article published in May 2019. DOI: 10.4244/EIJ-D-19-00034
Pil Sang Song1, Joo-Yong Hahn2, Hyeon-Cheol Gwon3, Ki-Hyun Jeon4, Cheol Woong Yu5, Seung-Woon Rha6, Chang-Hwan Yoon7, Myung Ho Jeong8,
1. Division of Cardiology, Heart Stroke Vascular Center, Mediplex Sejong General Hospital, Incheon, KOREA, REPUBLIC OF, 2. Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 3. Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 4. Division of Cardiology, Heart Stroke Vascular Center, Mediplex Sejong General Hospital, Incheon, 5. Cardiovascular Center, Anam Hospital, Korea University Medical Center, Seoul, 6. Cardiovascular Center, Korea University Guro Hospital, 7. Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, 8. Chonnam National University Hospital, Gwangju, all in Republic of Korea
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Aims: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 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] <30mL/min/1.73m2,mean: 19.1±7.5 mL/min/1.73m2) 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 end point was major adverse cardiac events (MACEs), composite of all-cause death, myocardial re-infarction, re-hospitalisation for heart failure, and any repeat revascularisation at 1-year. The safety outcome was the worsening of renal function (WRF) defined as a 30% reduction in estimated GFR from baseline to 12 months 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.