What is optimal revascularization strategy in patients with multivessel coronary artery disease in non-ST-elevation myocardial infarction? Multivessel or culprit-only revascularization

Title
What is optimal revascularization strategy in patients with multivessel coronary artery disease in non-ST-elevation myocardial infarction? Multivessel or culprit-only revascularization
Author(s)
김영조김민철[김민철]정명호[정명호]안영건[안영건]김종현[김종현]채승철[채승철]허성호[허성호]성인환[성인환]홍택정[홍택정]최동훈[최동훈]조명찬[조명찬]김종진[김종진]성기배[성기배]정욱성[정욱성]장양수[장양수]조성연[조성연]라성운[라성운]배장호[배장호]조정관[조정관]박성정[박성정]
Keywords
ACUTE KIDNEY INJURY; TASK-FORCE; INTERVENTION; CARDIOLOGY; ANGIOPLASTY; GUIDELINES; OUTCOMES; THERAPY
Issue Date
201112
Publisher
ELSEVIER IRELAND LTD
Citation
INTERNATIONAL JOURNAL OF CARDIOLOGY, v.153, no.2, pp.148 - 153
Abstract
Background: In patients with non-ST-elevation myocardial infarction (NSTEMI), current guidelines did not recommend optimal revascularization management in multivessel coronary artery disease. We compared clinical outcomes between multivessel revascularization and culprit-only revascularization in this setting. Methods: A total of 1919 patients with multivessel disease (1011 patients; multivessel revascularization group, 908 patients; culprit-only revascularization group) diagnosed as NSTEMI was enrolled in a nationwide prospective Korea Acute Myocardial Infarction Registry (KAMIR) from November 2005 to January 2008. The primary end-points were major adverse cardiac events (MACE), all-causes of deaths, myocardial infarction (MI), and repeated percutaneous coronary intervention (PCI) during 1-year clinical follow-up. Also, subgroup analysis was performed in patients with high TIMI (Thrombolysis In Myocardial Infarction) risk score (>= 4) to find efficacy of multivessel PCI in high-risk patients. Results: Baseline clinical characteristics and the risk factors of coronary artery disease were similar between both groups. In angiography, three-vessel lesion was more presented in the multivessel group (46.1% vs. 40.9%, p = 0.024) and rates of left anterior descending and left main stem coronary artery as culprit vessel were higher in the multivessel group (p = 0.003 and p = 0.001 respectively). In-hospital mortality was higher in the culprit-only group (1.4% vs. 2.9%, p = 0.025). Primary end-points occurred in 241 patients (15.5%) during 1-year follow-up. Multivessel revascularization reduced MACEs [hazard ratio (HR) 0.658, 95% confidence interval (CI) 0.45 to 0.96, p = 0.031], death or myocardial infarction (HR 0.58, 95% CI 0.35 to 0.97, p = 0.037) and non-target vessel revascularization (HR 0.44, 95% CI 0.24 to 0.81, p = 0.008). There were no significant differences in target lesion revascularization (TLR; HR 1.38, 95% CI 0.51 to 3.71, p = 0.529) and target vessel revascularization (TVR; HR 0.28, 95% CI 0.05 to 1.47, p = 0.131). In subgroup analysis in patients with a higher TIMI risk score, similar results were presented. Conclusion: Multivessel revascularization in multivessel coronary artery disease presenting with NSTEMI showed better clinical outcomes without significant in-stent restenosis and progression of diseased-vessel compared to culprit-only revascularization. (C) 2010 Elsevier Ireland Ltd. All rights reserved.
URI
http://hdl.handle.net/YU.REPOSITORY/24174http://dx.doi.org/10.1016/j.ijcard.2010.08.044
ISSN
0167-5273
Appears in Collections:
의과대학 > 내과학교실 > Articles
Files in This Item:
There are no files associated with this item.
Export
RIS (EndNote)
XLS (Excel)
XML


qrcode

Items in DSpace are protected by copyright, with all rights reserved, unless otherwise indicated.

BROWSE