Complete Revascularization Versus Treatment of the Culprit Artery Only in ST Elevation Myocardial Infarction: A Multicenter Registry

Cadore, Julia Cremona; Furtado, Mariana Vargas; Tumelero, Rogério Tadeu; Tognon, Alexandre Pereira; Krepsky, Ana Maria; Cadore, Denis; Ruschel, Karen Brasil; Bedin, Julia Caldas; Conte, Thais; Polanczyk, Carisi Anne

doi:10.36660/abc.20180346

Sumário Anterior Atual Seguinte

Sumário

Original Article • Arq. Bras. Cardiol. 115 (2) • Aug 2020 • https://doi.org/10.36660/abc.20180346 linkcopy

Complete Revascularization Versus Treatment of the Culprit Artery Only in ST Elevation Myocardial Infarction: A Multicenter Registry

Authorship SCIMAGO INSTITUTIONS RANKINGS

Background Data on the management and prognosis of patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease are limited in Brazil, showing that the available revascularization strategies should be investigated

Objective To assess the outcomes of complete revascularization versus treatment of the culprit artery only in patients with STEMI and multivessel disease.

Methods A prospective cohort study was conducted at two medical centers in southern Brazil with a 1-year follow-up after the index procedure. The primary outcome was a composite of cardiac death, reinfarction, or recurrent angina, while the secondary outcome was stroke, nonfatal cardiac arrest, major bleeding, or need for reintervention. The probability of outcomes occurring was compared between the groups using binary logistic regression. A p-value < 0.05 was considered statistically significant.

Results Eighty-five patients were included. Their mean age was 62±12 years, and 61 (71.8%) were male. Fifty-eight (68.2%) were treated with complete revascularization and 27 (31.8%) with incomplete revascularization. The chance of both the primary and secondary outcomes occurring was significantly greater among patients treated with incomplete revascularization when compared to those treated with complete revascularization (odds ratio [OR] 5.1, 95% confidence interval [CI] 1.6-16.1 vs. OR 5.2, 95% CI 1.2-22.9, respectively), as well as cardiac death (OR 6.4, 95% CI 1.2-35.3).

Conclusion Registry data from two centers in southern Brazil demonstrate that the complete revascularization strategy is associated with a significant reduction in primary and secondary outcomes in a 1-year follow-up when compared to the incomplete revascularization strategy (Arq Bras Cardiol. 2020; 115(2):229-237)

ST Elevation Myocardial Infarction/mortality, Cohort Studies; Hemodynamic; Death Certificates; Angina Pectoris; Stroke; Heart Arrest; Angina Pectoris; Stroke; Heart Arrest; Percutaneous Coronary Interventions

		Revascularization strategy
	Overall	Complete	Incomplete	p
Center				0.43
1	28 (32.9%)	17 (60.7%)	11 (39.3%)
2	57 (67.1%)	41 (71.9%)	16 (28.1%)
Age (years)	62±12	62.7±12	60.6±13	0.46
Male	61 (71.8%)	42 (72.4%)	19 (74.0%)	0.99
White	80 (94.1%)	55 (94.8%)	25 (92.6%)	0.99
Previous history
Hypertension	54 (63.5%)	37 (63.8%)	17 (63.0%)	0.99
Diabetes	22 (25.9%)	14 (24.1%)	8 (29.6%)	0.79
Smoking	26 (30.6%)	21 (36.2%)	5 (18.5%)	0.16
Previous CAD	10 (11.8%)	5 (8.6%)	5 (18.5%)	0.34
AMI location				0.94*
Anterior	37 (43.5%)	26 (44.8%)	11 (40.7%)
Inferior	42 (49.4%)	28 (48.3%)	14 (51.9%)
Lateral	6 (7.1%)	4 (6.9%)	2 (7.4%)
LBBB	4 (4.7%)	2 (3.4%)	2 (7.4%)	0.80*
No. of stenoses				0.87
2	67 (78.8%)	46 (79.3%)	21 (77.8%)
3	18 (21.1%)	12 (20.7%)	6 (22.2%)
LAD				0.28
Culprit	32 (37.6%)	22 (37.9%)	10 (37.0%)
Nonculprit	36 (42.4%)	27 (46.6%)	9 (33.3%)
No lesion	17 (20.0%)	9 (15.5%)	8 (29.6%)
LVEF < 50%	41 (48.2%)	25 (43.1%)	16 (59.3%)	0.25
Killip class				0.62*
1	71 (83.5%)	50 (86.2%)	21 (77.8%)
2	7 (8.2%)	4 (6.9%)	3 (11.1%)
3	7 (8.2%)	4 (6.9%)	3 (11.1%)

		Revascularization strategy
	Overall	Complete	Incomplete	p
Previous thrombolytic therapy	3 (3.5%)	3 (5.2%)	0	0.57*
Stent type				0.30*
Bare-metal	76 (89.4%)	50 (86.2%)	26 (96.3%)
Drug-eluting	9 (10.6%)	8 (13.8%)	1 (3.7%)
Glycoprotein IIb/IIIa inhibitors	23 (27.1%)	14 (24.1%)	9 (33.3%)	0.53
Medical therapy within 24 h
ASA	85 (100%)	58 (100%)	27 (100%)	-
Clopidogrel	85 (100%)	58 (100%)	27 (100%)	-
Statin	85 (100%)	58 (100%)	27 (100%)	-
Beta-blocker	43 (50.6%)	26 (44.8%)	17 (63.0%)	0.19
ACEI/ARB	40 (47.1%)	27 (46.6%)	13 (48.1%)	0.99
Nitrate	30 (35.3%)	20 (34.5%)	10 (37.0%)	0.99
SYNTAX score				0.34*
Low	41 (48.2%)	30 (51.7%)	11 (40.7%)
Moderate	44 (51.8%)	28 (48.3%)	16 (59.3%)
High	—	—	—

		Revascularization strategy
	Complete n (%)	Incomplete n (%)	OR (95% CI)	p
Primary outcome (composite)	6 (10.3%)	10 (37.0%)	5.10 (1.6-16.1)	0.005
Cardiac death	2 (3.4%)	5 (18,5%)
Reinfarction	—	—
Angina	4 (6.9%)	5 (18.5%)
Secondary outcome (composite)	3 (5.17%)	6 (22.2%)	5.24 (1.2-22.9)	0.022
Stroke	—	—
Nonfatal cardiac arrest	2 (3.4%)	—
Major bleeding	1 (1.7%)	—
Reintervention	—	6 (22.2%)

	Primary outcome* OR (95% CI)	Secondary outcome^†OR (95% CI)
Unadjusted	5.1 (1.6-16.1)	5.2 (1.2-22.9)
Model 2 ^‡	5.2 (1.6-16.5)	5.1 (1.1-23.0)
Model 3 ^§	5.1 (1.6-16.4)	4.9 (1.1-23.1)
Model 4 ^//	5.1 (1.6-16.4)	5.1 (1.1-24.1)
Model 5 ^¶	5.1 (1.6-16.7)	4.3 (0.9-21.0)
Model 6 ^#	4.6 (1.4-15.3)	3.6 (0.7-19.6)
Model 7**	4.7 (1.4-15.7)	2.3 (0.4-14.2)

location_on

Sociedade Brasileira de Cardiologia - SBC Avenida Marechal Câmara, 160, sala: 330, Centro, CEP: 20020-907, (21) 3478-2700 - Rio de Janeiro - RJ - Brazil, Fax: +55 21 3478-2770 - São Paulo - SP - Brazil
E-mail: revista@cardiol.br

rss_feed Acompanhe os números deste periódico no seu leitor de RSS

[TFN1001] Values are mean ± standard deviation or absolute and relative frequency. p: probability value; analysis of variance was used for age; for the others, Pearson’s chi-square text or *Fischer’s exact test was used. CAD: coronary artery disease; AMI: acute myocardial infarction; LBBB: left bundle branch block; LAD: left anterior descending artery; LVEF: left ventricular ejection fraction.