Key result
Having 2 or more diseased vessels or a diseased left main trunk was an independent predictor of in-hospital mortality (OR 2.973) in primary PCI-treated acute myocardial infarction patients requiring mechanical support devices.
Why the study?
Does the requirement of mechanical support devices (IABP/PCPS) alter the predictors of in-hospital mortality in patients undergoing primary PCI for acute myocardial infarction?
Cohort (n=1,785)
Yes
Does the requirement of mechanical support devices (IABP/PCPS) alter the predictors of in-hospital mortality in patients undergoing primary PCI for acute myocardial infarction?
Odds Ratio: 2.973 (95% CI 1.443–6.124)
p-value: p=0.0031
In AMI patients requiring mechanical support during primary PCI, multivessel or left main disease is a strong independent predictor of in-hospital mortality, suggesting that culprit-only PCI may be insufficient in this high-risk population.
Multivessel or left main disease predicts higher mortality in AMI patients on mechanical support; leaves open whether complete revascularization improves outcomes.
BACKGROUND: Predictors of in-hospital outcome after primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) requiring mechanical support devices such as intra-aortic balloon pumping (IABP) and/or percutaneous cardiopulmonary support (PCPS) remain unclear. METHODS AND RESULTS: Using the AMI-Kyoto Multi-Center Risk Study database, clinical background, angiographic findings, results of primary PCI, and in-hospital prognosis were retrospectively compared between primary PCI-treated AMI patients requiring mechanical assist devices (with-IABP/PCPS patients, n=275) and those without (without-IABP/PCPS patients, n=1,510). The with-IABP/PCPS patients were more likely to have a larger number of diseased vessels, lower Thrombolysis In Myocardial Infarction (TIMI) grade in the infarct-related artery (IRA) before/after primary PCI, and a significantly higher in-hospital mortality rate than the without-IABP/PCPS patients. On multivariate analysis, the number of diseased vessels > or =2 or diseased left main trunk (LMT) at initial coronary angiography (CAG) was the independent positive predictor of the in-hospital mortality in the with-IABP/PCPS patients, not in the without-IABP/PCPS patients, whereas acquisition of TIMI 3 flow in the IRA immediately after primary PCI was the negative predictor in the without-IABP/PCPS patients, not in the with-IABP/PCPS patients. CONCLUSIONS: The number of diseased vessels > or =2 or diseased LMT at initial CAG is an independent risk factor of in-hospital death in primary PCI-treated AMI patients requiring mechanical support devices.
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Shiraishi et al. (2010) conducted a cohort in Acute myocardial infarction (n=1,785). Number of diseased vessels ≥2 or diseased left main trunk vs. 0-1 diseased vessels was evaluated on In-hospital mortality (OR 2.973, 95% CI 1.443-6.124, p=0.0031). Having 2 or more diseased vessels or a diseased left main trunk was an independent predictor of in-hospital mortality (OR 2.973) in primary PCI-treated acute myocardial infarction patients requiring mechanical support devices.
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