Coronary artery disease
Impact of Multivessel Coronary Artery Disease and Noninfarct-Related Artery Revascularization on Outcome of Patients With ST-Elevation Myocardial Infarction Transferred for Primary Percutaneous Coronary Intervention (from the EUROTRANSFER Registry)

https://doi.org/10.1016/j.amjcard.2010.03.029Get rights and content

The aim of the study was to assess the impact of multivessel coronary artery disease (MVD) and noninfarct-related artery (non-IRA) revascularization during index percutaneous coronary intervention (PCI) on outcomes of patients with ST-segment elevation myocardial infarction (STEMI). Data on 1,598 of 1,650 patients with complete angiographic data, with ≥1 significantly stenosed epicardial coronary artery, and without previous coronary artery bypass grafting were retrieved from the EUROTRANSFER Registry database. Patients with 1-, 2-, and 3-vessel disease made up 48.5%, 32.0%, and 19.5% of the registry population, respectively. Patients with MVD were less likely to achieve final Thrombolysis In Myocardial Infarction grade 3 flow (1- vs 2- vs 3-vessel disease, 93.6% vs 89.3% vs 87.9%, respectively, p = 0.003) and ST-segment resolution >50% within 60 minutes after PCI (1- vs 2- vs 3-vessel disease, 80.9% vs 77.5% vs 69.3%, respectively, p <0.001). They were also at higher risk of death during 1-year follow-up (1- vs 2- vs 3-vessel disease, 4.9% vs 7.4% vs 13.5%, respectively, p <0.001), and MVD was identified as an independent predictor of 1-year death. In 70 patients (9%) non-IRA PCI was performed during index PCI. These patients were at higher risk of 30-day and 1-year death compared to patients without non-IRA PCI, but this difference in mortality was no longer significant after adjustment for covariates. In conclusion, patients with MVD have decreased epicardial and myocardial reperfusion success and had worse prognosis after primary PCI for STEMI compared to patients with 1-vessel disease. In this large multicenter registry, non-IRA PCI during the index procedure was performed in 9% of patients with MVD and it was associated with increased 1-year mortality.

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Methods

A detailed description of the EUROTRANSFER Registry (http://ClinicalTrials.gov, number NCT00378391) protocol and main results have been previously published.19, 20 In this registry data concerning 1,650 consecutive, transferred patients with STEMI in 15 STEMI hospital networks from 7 European countries from November 2005 to January 2007 were collected. For the present analysis data of 1,598 patients with complete angiographic data, with ≥1 significantly stenosed epicardial coronary artery, and

Results

Data on 1,598 patients were retrieved from the EUROTRANSFER Registry database. Patients with 1-, 2-, and 3-vessel disease made up 48.5%, 32.0%, and 19.5% of the registry population, respectively. As presented in Table 1, patients with MVD were older, with a higher prevalence of diabetes mellitus, previous MI, previous heart failure symptoms, previous PCI, and presenting in a higher Killip class on admission than were patients with 1-vessel disease. There was no difference in initial

Discussion

In this study we confirmed findings from previous reports concerning an unfavorable prognosis of patients with MVD presenting with STEMI.1, 2, 3 Prevalence of MVD in the EUROTRANSFER Registry was similar to the prevalence observed in previous reports1, 2, 3, 4, 5 and MVD was associated with a higher prevalence of diabetes mellitus, previous chronic heart failure symptoms, and advanced age.2, 3, 21 In addition, in patients with MVD, a trend toward higher frequency of chronic renal failure and

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The EUROTRANSFER Registry was an academic research project supported by a research grant from Eli Lilly and Company, Critical Care Europe, Geneva, Switzerland.

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