Clinical Outcomes of Complete Revascularization in Acute Myocardial Infarction Patients With High Bleeding Risk and Multivessel Disease

Figures

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  Figure 1. Study flow. A total of 13 460 patients with AMI and multivessel disease who underwent successful PCI were included in the study. Of these, 4401 patients were classified as the group with HBR. Both the groups with and without HBR were further subdivided based on whether CR was performed for non‐IRA lesions. Group with HBR: CR (n=1577), IR (n=2824). Group without HBR: CR (n=3911), IR (n=5148). AMI indicates acute myocardial infarction; CR, complete revascularization; HBR, high bleeding risk; IR, incomplete revascularization; IRA, infarct‐related artery; KAMIR‐NIH, Korea Acute Myocardial Infarction Registry‐National Institutes of Health; KAMIR‐V, Korea Acute Myocardial Infarction Registry‐V; and PCI, percutaneous coronary intervention.

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  Figure 2. Primary end point according to complete revascularization, stratified by high bleeding risk. A, High bleeding risk, B, Non‐high bleeding risk. The primary end point was a composite of death, myocardial infarction, repeat revascularization, stent thrombosis, or cerebrovascular events. Patients who underwent CR were associated with lower risk of MACCE than those with IR in both groups with and without HBR. Covariables included in the multivariable‐adjusted Cox regression model were age, sex, body mass index, center, initial presentation, 3‐vessel disease, location of culprit lesion and left main disease, previous myocardial infarction, cerebrovascular accident, heart failure, diabetes, hypertension, left ventricular ejection fraction <50%, estimated glomerular filtration rate <60 mL/min/1.73 m2 at admission, current smoking, potent P2Y12 inhibitor use, radial access, use of intravascular ultrasound, beta blocker, use of venoarterial extracorporeal membrane oxygenation, and intra‐aortic balloon pump. CR indicates complete revascularization; HBR, high bleeding risk; HR, hazard ratio, IR, incomplete revascularization; and MACCE, major adverse cardiac and cerebrovascular event.

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  Figure 3. Cumulative incidence of bleeding according to complete revascularization, stratified by high bleeding risk. A, High bleeding risk, B, Non‐high bleeding risk comparison of bleeding events between CR and IR based on HBR status. The incidence of bleeding events was comparable between the CR and IR groups in both the groups with and without HBR. Covariables included in the multivariable‐adjusted Cox regression model were age, sex, body mass index, center, initial presentation, 3‐vessel disease, location of culprit lesion and left main disease, previous myocardial infarction, cerebrovascular accident, heart failure, diabetes, hypertension, left ventricular ejection fraction <50%, estimated glomerular filtration rate <60 mL/min/1.73 m2 at admission, current smoking, potent P2Y12 inhibitor use, radial access, use of intravascular ultrasound, beta blocker, use of venoarterial extracorporeal membrane oxygenation and intra‐aortic balloon pump. CR indicates complete revascularization; HR, hazard ratio; and IR, incomplete revascularization.

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  Figure 4. Subgroup analysis regarding MACCE in the group with HBR. CR was associated with a lower incidence of MACCE across various subgroups of patients with HBR. CR consistently reduced the risk of MACCE regardless of sex, age, initial presentation, chronic kidney disease, and lesion complexity, such as 3‐vessel disease, in patients with HBR without significant interaction. CR indicates complete revascularization; eGFR, estimated glomerular filtration rate; HBR, high bleeding risk; MACCE, major adverse cardiac and cerebrovascular event; and MI, myocardial infarction.