Key result
Non-culprit coronary intervention during primary PCI was associated with an increased hazard of 90-day mortality compared to infarct-related artery PCI alone (adjusted HR 2.44; 95% CI 1.55-3.83; P<0.001).
Why the study?
Does non-culprit coronary artery PCI at the time of primary PCI improve 90-day outcomes in STEMI patients with multi-vessel disease?
Observational (n=2,201)
Does non-culprit coronary artery PCI at the time of primary PCI improve 90-day outcomes in STEMI patients with multi-vessel disease?
Performing non-culprit PCI at the time of primary PCI in STEMI patients with multi-vessel disease is associated with significantly increased 90-day mortality.
Answers are grounded in this paper and cite their sources.
May increase 90-day mortality risk with non-culprit PCI at primary PCI; leaves open confirmation in randomized trials.
AIMS: To examine the incidence of and propensity for non-culprit interventions performed at the time of the primary percutaneous coronary intervention (PCI) and its association with 90-day outcomes. METHODS AND RESULTS: We examined the incidence, propensity for, and associated 90-day outcomes following non-culprit interventions performed at the time of primary PCI among ST-elevation myocardial infarction patients with multi-vessel coronary artery disease (MVD). Of the 5373 patients who underwent primary PCI in the APEX-AMI trial, 2201 had MVD. Of those, 217 (9.9%) underwent non-infarct-related arteries (IRA) PCI, whereas 1984 (90.1%) underwent PCI of the IRA alone. Ninety-day death and death/CHF/shock were higher in the non-IRA group compared with the IRA-only PCI group (12.5 vs. 5.6%, P (log-rank) < 0.001 and 17.4 vs. 12.0%, P (log-rank) = 0.020, respectively). After adjusting for patient and procedural characteristics as well as propensity for performing non-IRA PCI, this procedure remained independently associated with an increased hazard of 90-day mortality [adjusted hazard ratio 2.44, 95% CI (1.55-3.83), P < 0.001]. CONCLUSION: Non-culprit coronary interventions were performed at the time of primary PCI in 10% of MVD patients and were significantly associated with increased mortality. Our data support current guideline recommendations discouraging the performance of such procedures in stable primary PCI patients. Prospective randomized study of this issue may be warranted.
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Toma et al. (2010) conducted an observational in ST-elevation myocardial infarction with multi-vessel coronary artery disease (n=2,201). Non-culprit coronary artery percutaneous coronary intervention (non-IRA PCI) vs. PCI of the infarct-related artery (IRA) alone was evaluated on 90-day mortality (adjusted HR 2.44, 95% CI 1.55-3.83, p=< 0.001). Non-culprit coronary intervention during primary PCI was associated with an increased hazard of 90-day mortality compared to infarct-related artery PCI alone (adjusted HR 2.44; 95% CI 1.55-3.83; P<0.001).
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