Korean Circ J.  2018 Nov;48(11):989-999. 10.4070/kcj.2017.0387.

Complete Versus Culprit-Only Revascularization for ST-Segment Elevation Myocardial Infarction and Multivessel Disease in the 2(nd) Generation Drug-Eluting Stent Era: Data from the INTERSTELLAR Registry

Affiliations
  • 1Department of Cardiology, Inha University Hospital, Incheon, Korea. denki1@inha.ac.kr
  • 2Department of Cardiology, Gachon University Gil Medical Center, Incheon, Korea.
  • 3Department of Cardiology, Sejong General Hospital, Bucheon, Korea.
  • 4Department of Cardiology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea. denki1@inha.ac.kr

Abstract

BACKGROUND AND OBJECTIVE
S: We aimed to compare outcomes of complete revascularization (CR) versus culprit-only revascularization for ST-segment elevation myocardial infarction (STEMI) and multivessel disease (MVD) in the 2nd generation drug-eluting stent (DES) era.
METHODS
From 2009 to 2014, patients with STEMI and MVD, who underwent primary percutaneous coronary intervention (PCI) using a 2nd generation DES for culprit lesions were enrolled. CR was defined as PCI for a non-infarct-related artery during the index admission. Major adverse cardiovascular event (MACE) was defined as cardiovascular (CV) death, non-fatal myocardial infarction, target lesion revascularization, or heart failure during the follow-up year.
RESULTS
In total, 705 MVD patients were suitable for the analysis, of whom 286 (41%) underwent culprit-only PCI and 419 (59%) underwent CR during the index admission. The incidence of MACE was 11.5% in the CR group versus 18.5% in the culprit-only group (hazard ratio [HR], 0.56; 95% confidence interval [CI], 0.37-0.86; p<0.01; adjusted HR, 0.64; 95% CI, 0.40-0.99; p=0.04). The CR group revealed a significantly lower incidence of CV death (7.2% vs. 12.9%; HR, 0.51; 95% CI, 0.31-0.86; p=0.01 and adjusted HR, 0.57; 95% CI; 0.32-0.97; p=0.03, respectively).
CONCLUSIONS
CR was associated with better outcomes including reductions in MACE and CV death at 1 year of follow-up compared with culprit-only PCI in the 2nd generation DES era.

Keyword

ST elevation myocardial infarction; Percutaneous coronary intervention

MeSH Terms

Arteries
Drug-Eluting Stents*
Follow-Up Studies
Heart Failure
Humans
Incidence
Myocardial Infarction*
Percutaneous Coronary Intervention
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