Korean J Intern Med.  2015 Mar;30(2):177-190. 10.3904/kjim.2015.30.2.177.

Effect of revascularization strategy in patients with acute myocardial infarction and renal insufficiency with multivessel disease

• Park H
• Hong YJ
• Rhew SH
• Kim SS
• Jeong YW
• Jeong HC
• Cho JY
• Jang SY
• Lee KH
• Park KH
• Sim DS
• Yoon NS
• Yoon HJ
• Kim KH
• Park HW
• Kim JH
• Ahn Y
• Jeong MH
• Cho JG
• Park JC

• KMID: 2160682
• DOI: http://doi.org/10.3904/kjim.2015.30.2.177

Abstract

BACKGROUND/AIMS
The aim of this study was to compare the risk of complications and outcome between infarct-related artery (IRA)-only revascularization and multivessel (MV) revascularization in patients with acute myocardial infarction (MI) with renal insufficiency and MV disease.
METHODS
A total of 1,031 acute MI patients with renal insufficiency and MV disease who were registered in the Korea Working Group on Myocardial Infarction were enrolled. They were divided into two groups (IRA-only revascularization group, n = 404; MV revascularization group, n = 627), and investigated the cumulative incidence of major adverse cardiac events (MACE) and the incidence of complications after percutaneous coronary intervention (PCI).
RESULTS
Complications after PCI occurred in 19.9% of all patients (206/1,031). Complications after PCI occurred more frequently in the MV revascularization group compared with the IRA-only revascularization group (20.1% [126/627] vs. 15.3% [62/404], respectively; p = 0.029]. The overall in-hospital mortality rate was 6.3%, and there was no significant difference between the groups (5.2% in the IRA-only revascularization group vs. 7.0% in the MV revascularization group; p = 0.241). The total incidence of MACE was 11.1%, and there was no significant difference between the groups (11.6% in the IRA-only revascularization group vs. 10.7% in the MV revascularization group; p = 0.636).
CONCLUSIONS
The incidence of complications after PCI was significantly lower in the IRA-only revascularization group compared with the MV revascularization group. However, there were no significant difference in the 12-month outcomes between groups in patients with acute MI and renal insufficiency with MV disease.

Keyword

Myocardial infarction; Percutaneous coronary intervention; Glomerular filtration rate

MeSH Terms

Aged
Aged, 80 and over
Coronary Artery Disease/complications/diagnosis/mortality/*therapy
Female
Glomerular Filtration Rate
Hospital Mortality
Humans
Kaplan-Meier Estimate
Kidney/physiopathology
Male
Middle Aged
Myocardial Infarction/complications/diagnosis/mortality/*therapy
Percutaneous Coronary Intervention/adverse effects/*methods/mortality
Prospective Studies
Recurrence
Registries
Renal Insufficiency/diagnosis/*etiology/mortality/physiopathology
Republic of Korea
Risk Factors
Time Factors
Treatment Outcome