Key result
Multivessel coronary artery disease was an independent predictor of re-MI and ventricular remodeling at a median 32 months in STEMI patients treated by PPCI.
Why the study?
Does multivessel coronary artery disease worsen early ischemic injury and late clinical outcomes in STEMI patients treated by primary PCI?
Cohort (n=288)
Does multivessel coronary artery disease worsen early ischemic injury and late clinical outcomes in STEMI patients treated by primary PCI?
In STEMI patients treated with primary PCI, multivessel disease worsens long-term clinical outcomes and ventricular remodeling due to recurrent ischemic events rather than larger initial infarct size.
Answers are grounded in this paper and cite their sources.
May identify STEMI patients for intensified secondary prevention post-PPCI; leaves open whether multivessel revascularization improves remodeling.
OBJECTIVE: The mechanism through which multivessel coronary artery disease (MVD) adversely affects the outcome of patients with ST-elevation myocardial infarction (STEMI) is poorly characterized. We assessed whether the impact of MVD on outcome of STEMI patients is because of ischemic damage after primary percutaneous coronary intervention (PPCI) or to late ischemic events. METHODS: From August 2005 to 2007, 288 STEMI patients treated by (bare metal) stent-PPCI were prospectively enrolled. The ischemic injury early after PPCI (evaluated by multiparametric approach) and the incidence of late adverse cardiovascular events were compared between the two groups. RESULTS: Compared with single vessel coronary artery disease, MVD patients (n=134) were older, with higher prevalence of diabetes, prior MI, anterior MI and higher collateral score. Myocardial perfusion as assessed by myocardial blush and SigmaST-segment resolution was similar in the two groups as well as the infarct size and microvascular obstruction as assessed by Troponin I and by the delayed enhancement of cardiac magnetic resonance. At clinical (98% complete) and echocardiogaphic (94% complete) follow-up (median 32 months) MVD patients showed a higher incidence of re-MI (6.1 vs. 1.3%), and urgent revascularization (8.3 vs. 2.7%) and worse left ventricular remodeling than single vessel disease patients. At propensity adjusted analysis MVD was an independent predictor of re-MI (odds ratio: 5.7) and ventricular remodeling (odds ratio: 2.2). CONCLUSION: The impact of MVD on clinical outcome and remodeling of STEMI patients is not because of the extent of ischemic damage observed after PPCI, but to recurrent ischemic events during follow-up.
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Tarantini et al. (2010) conducted a cohort in ST-elevation myocardial infarction (STEMI) (n=288). Multivessel coronary artery disease (MVD) vs. Single vessel coronary artery disease was evaluated on re-MI (OR 5.7). Multivessel coronary artery disease was an independent predictor of re-MI and ventricular remodeling at a median 32 months in STEMI patients treated by PPCI.
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