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Culprit Vessel Percutaneous Coronary Intervention Versus Multivessel and Staged Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction Patients With Multivessel Disease

Edward L. Hannan, PhD^_*,_*, Zaza Samadashvili, MD^_*, Gary Walford, MD, David R. Holmes, Jr, MD, Alice K. Jacobs, MD, Nicholas J. Stamato, MD^||, Ferdinand J. Venditti, MD^¶, Samin Sharma, MD^#, Spencer B. King, III, MD^_**

^_* University at Albany, State University of New York, Albany, New York
St. Joseph's Hospital, Syracuse, New York
Mayo Clinic, Rochester, Minnesota
Boston Medical Center, Boston, Massachusetts
^|| United Health Services, Binghamton, New York
^¶ Albany Medical Center, Albany, New York
^# Mount Sinai Medical Center, New York, New York
^_** St. Joseph's Health System, Atlanta, Georgia

^_* Reprint requests and correspondence: Dr. Edward L. Hannan, Distinguished Professor and Associate Dean for Research, School of Public Health, State University of New York, University at Albany, One University Place, Rensselaer, New York, 12144-3456 (Email: elh03{at}health.state.ny.us).

Objectives: The purpose of this study was to examine the differences in in-hospital and longer-term mortality for ST-segment elevation myocardial infarction (STEMI) patients with multivessel disease as a function of whether they underwent single-vessel (culprit vessel) percutaneous coronary interventions (PCIs) or multivessel PCI.

Background: The optimal treatment of patients with STEMI and multivessel disease is of continuing interest in the era of drug-eluting stents.

Methods: STEMI patients with multivessel disease undergoing PCIs in New York between January 1, 2003, and June 30, 2006, were subdivided into those who underwent culprit vessel PCI and those who underwent multivessel PCI during the index procedure, during the index admission, or staged within 60 days of the index admission. Patients were propensity-matched and mortality rates were calculated at 12, 24, and 42 months.

Results: A total of 3,521 patients (87.5%) underwent culprit vessel PCI during the index procedure. A total of 259 of them underwent staged PCI during the index admission and 538 patients underwent staged PCI within 60 days of the index procedure. For patients without hemodynamic compromise, culprit vessel PCI during the index procedure was associated with lower in-hospital mortality than multivessel PCI during the index procedure (0.9% vs. 2.4%, p = 0.04). Patients undergoing staged multivessel PCI within 60 days after the index procedure had a significantly lower 12-month mortality rate than patients undergoing culprit vessel PCI only (1.3% vs. 3.3%, p = 0.04).

Conclusions: Our findings support the American College of Cardiology/American Heart Association (ACC/AHA) recommendation that culprit vessel PCI be used for STEMI patients with multivessel disease at the time of the index PCI when patients are not hemodynamically compromised. However, staged PCI within 60 days after the index procedure, including during the index admission, is associated with risk-adjusted mortality rates that are comparable with the rate for culprit vessel PCI alone.

Key Words: culprit vessel revascularization • multivessel revascularization • primary PCI • ST-segment elevation myocardial infarction

Abbreviations and Acronyms   ACC/AHA = American College of Cardiology/American Heart Association   PCI = percutaneous coronary intervention   PCIRS = Percutaneous Coronary Interventions Reporting System   STEMI = ST-segment elevation myocardial infarction   TIMI = Thrombolysis In Myocardial Infarction

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