Author + information
- Vladimir Ivanovich Ganyukov,
- Roman S. Tarasov,
- Pavel Andreevich Shushpannikov,
- Olga Leonidovna Barbarash and
- Leonid Semenovich Barbarash
There is no evidence to apply a differentiated approach to the choice of revascularization strategy for patients with ST-elevation myocardial infarction (STEMI) and multivessel disease (MVD). Thirty-day and long-term outcomes of different strategies of revascularization in a cohort of STEMI patients with MVD, depending on the severity of coronary stenosis on a SYNTAX SCORE were analyzed.
Outcomes of different revascularization strategies in 227 STEMI patients in the aspect of an objective assessment of the severity of coronary lesions on a SYNTAX SCORE were studied. The first group consisted of patients who underwent multivessel stenting (MS) strategy in the primary PCI (n = 40), the second group consisted of patients defined by staged revascularization (SR) (n = 187). Each group was divided into subgroups according to severity of coronary lesions on a SYNTAX SCORE: SYNTAX ≤ 22 (moderate) and SYNTAX ≥ 23 (severe).
Subgroups of patients with SYNTAX ≥ 23, as a group, MS, and SR group at baseline were associated with decreased left ventricular ejection fraction compared with subgroups SYNTAX ≤ 22 (p <0.05). In the SR group,as for 30 days and within 12 months observation was significantly more frequent need for non-target vessel revascularization(non-TVR) compared with the group of MS, 13.3% vs 0, and 50.3% vs 15%, respectively (p <0.05). In 12 months observation SR group had combined end-point (death + myocardial infarction + target vessel revascularization (TVR)) 23% vs. 7.5% in the MS group (p <0.05). SYNTAX ≥ 23 in the SR group compared with SYNTAX» ≤ 22 was associated with significantly greater frequency of death, 11.5% vs. 2.75% (p<0.05) and combined end-point, 29.5% vs. 18.3% (p <0.05), respectively for 12 months observation.
In a cohort of STEMI patients with MVD revealed the relationship between severe coronary stenosis (SYNTAX ≥ 23) and a number of clinical and angiographic parameters, in particular, is reflected in the frequency of adverse outcomes at 12 months of observation. The strategy of MS had satisfactory results at 12 months of observation regardless of the severity of coronary lesions, whereas patients with SR group (SYNTAX ≥ 23) showed worse outcomes compared with patients with moderate severity of coronary lesions (SYNTAX ≤ 22).
- 2013 American College of Cardiology Foundation