Key result
Multivessel disease in STEMI is linked to ~82% higher 1-year mortality than single vessel disease.
Why the study?
There is no dedicated risk scoring system for prognosis estimation of multivessel disease in STEMI patients despite its known impact on poor outcomes.
Does a novel risk scoring system accurately estimate the 1-year risk of all-cause death in STEMI patients with multivessel disease undergoing PCI?
Cohort (n=6,615)
Yes
Does a novel risk scoring system accurately estimate the 1-year risk of all-cause death in STEMI patients with multivessel disease undergoing PCI?
A novel 6-factor risk scoring system provides a simplified and validated tool to estimate 1-year mortality in STEMI patients with multivessel disease treated with PCI.
May refine mortality estimation in multivessel STEMI; leaves open whether the score alters management or outcomes in prospective studies.
Multivessel disease (MVD) is an independent risk factor for poor prognosis in acute myocardial infarction patients. Although several global risk scoring systems (RSS) are in use in clinical practice, there is no dedicated RSS for MVD in ST-segment elevation myocardial infarction (STEMI). The primary objective of this study is to develop a novel RSS to estimate the prognosis of patients with MVD in STEMI.We used the Korean Acute Myocardial Infarction Registry (KAMIR) to identify 2,030 STEMI patients with MVD who underwent appropriate percutaneous coronary intervention (PCI). Their data were analyzed to develop a new RSS. The prognostic power of this RSS was validated with 2,556 STEMI patients with MVD in the Korean Working Group on Myocardial Infarction Registry (KORMI).Six prognostic factors related to all-cause death in STEMI patients with MVD were age, serum creatinine, Killip Class, lower body weight, decrease in left ventricular ejection fraction, and history of cerebrovascular disease. The RSS for all-cause death was constructed using these risk factors and their statistical weight. The RSS had appropriate performance (c-index: 0.72) in the KORMI validation cohort.We developed a novel RSS that estimates all-cause death in the year following discharge for patients with MVD in STEMI appropriately treated by PCI. This novel RSS was transformed into a simple linear risk score to yield a simplified estimate prognosis of MVD among STEMI patients.
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Ryu et al. (2019) conducted a cohort in ST-segment elevation myocardial infarction (n=6,615). Multivessel disease vs. Single vessel disease was evaluated on 1-year all-cause death (p=0.01). Multivessel disease in STEMI patients was associated with a significantly higher 1-year all-cause mortality compared to single vessel disease (3.1% vs 1.7%), prompting the development of a validated risk scoring system.
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