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June 8, 2010European Heart Journal

Non-culprit coronary artery percutaneous coronary intervention during acute ST-segment elevation myocardial infarction: insights from the APEX-AMI trial

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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?

Population

2,201 ST-elevation myocardial infarction patients with multi-vessel coronary artery disease undergoing…

Comparison

Non-infarct-related arteries PCI performed at… vs PCI of the infarct-related artery (IRA) alone

Design

Cohort

Follow-up

90 days

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).

Authors

MTMustafa TomaCBChristopher E. BullerCWCynthia M. Westerhout

Discussion

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Overview

May increase 90-day mortality risk with non-culprit PCI at primary PCI; leaves open confirmation in randomized trials.

Study Design

Type

Observational (n=2,201)

Structured PICO

Does non-culprit coronary artery PCI at the time of primary PCI improve 90-day outcomes in STEMI patients with multi-vessel disease?

P
Population
2,201 ST-elevation myocardial infarction patients with multi-vessel coronary artery disease undergoing primary PCI, followed for 90 days.
E
Exposure
Non-infarct-related arteries (IRA) PCI (non-culprit intervention) performed at the time of primary PCI
C
Comparator
PCI of the infarct-related artery (IRA) alone
O
Outcome
90-day mortality (death)hard clinical

Main Result

Hazard Ratio: 2.44 (95% CI 1.55–3.83)

Absolute Event Rate: 12.5% vs 5.6%

p-value: p=< 0.001

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.

Cite This Study

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).

synapsesocial.com/papers/6a830c70ee90e576a3af871chttps://doi.org/10.1093/eurheartj/ehq129
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