Korean J Intern Med.  2019 Mar;34(2):324-334. 10.3904/kjim.2017.169.

A score for decision making during percutaneous coronary intervention in acute myocardial infarction patients with multivessel disease

Affiliations
  • 1Department of Cardiology, Cardiovascular Center, Miraero 21 Hospital, Gwangju, Korea.
  • 2Department of Cardiology, Cardiovascular Center, Chonnam National University Hospital, Gwangju, Korea. cecilyk@hanmail.net
  • 3Department of Cardiology, Chosun University Hospital, Gwangju, Korea.
  • 4Department of Cardiology, Cardiovascular Center, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.

Abstract

BACKGROUND/AIMS
The optimal percutaneous coronary intervention (PCI) strategy in patients with acute myocardial infarction (AMI) with multivessel disease (MVD) is uncertain. This study was designed to develop a novel and simple tool for assessing an individualized and optimized PCI strategy in AMI patients with MVD.
METHODS
In total, 5,025 patients with AMI from nine centers at two universities were enrolled in the prospective Convergent Registry of Catholic and Chonnam University for Acute Myocardial Infarction (COREA-AMI) registry from January 2004 through December 2009. From among them, we selected 2,630 patients with MVD who were treated by culprit-only or multivessel (MV) PCI. We investigated major adverse cardiac events (MACEs) during a 1-year clinical follow-up. Using a subgroup analysis, we extracted variables for use in the culprit only versus multivessel revascularization (CONVERSE) score, which showed a preference for MV PCI rather than culprit-only PCI for treating MVD.
RESULTS
The CONVERSE score was constructed using eight independent variables (1 point for each variable): age > 65 years, hypertension, diabetes mellitus, high Killip class (III or IV), low left ventricular ejection fraction (≤ 50%), low creatinine clearance (≤ 60 mL/min), high level of high-sensitivity C-reactive protein (≥ 2.0 mg/L), and left anterior descending artery or left main as the nonculprit vessel. The incidence of MACEs increased linearly with the CONVERSE score. The receiver operating characteristic curve showed that the cutoff value was 3 points.
CONCLUSIONS
The results suggest that patients with a CONVERSE score of 3 or more should undergo MV PCI.

Keyword

Percutaneous coronary intervention; Myocardial infarction; Prognosis

MeSH Terms

Arteries
C-Reactive Protein
Creatinine
Decision Making*
Diabetes Mellitus
Follow-Up Studies
Humans
Hypertension
Incidence
Jeollanam-do
Myocardial Infarction*
Percutaneous Coronary Intervention*
Prognosis
Prospective Studies
ROC Curve
Stroke Volume
C-Reactive Protein
Creatinine
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