Multivessel vs culprit-only percutaneous coronary intervention among patients 65 years or older with acute myocardial infarction.

Published

Journal Article

BACKGROUND: Older adults presenting with acute myocardial infarction (MI) often have multivessel coronary artery disease amenable to percutaneous coronary intervention (PCI), yet the risks of multivessel intervention may outweigh potential benefits in these patients. We sought to determine if nonculprit intervention during the index PCI is associated with better outcomes among older patients with acute MI and multivessel disease. METHODS: We examined 19,271 ST-segment elevation MI (STEMI) and 31,361 non-STEMI (NSTEMI) patients 65years or older with multivessel disease in a linked CathPCI Registry-Medicare database, excluding patients with prior coronary artery bypass grafting, left main disease, or cardiogenic shock. Using inverse probability-weighted propensity adjustment, we compared mortality between patients receiving culprit-only vs multivessel intervention during the index PCI procedure. RESULTS: Most older MI patients (91% STEMI and 74% NSTEMI) received culprit-only intervention during the index PCI. Among STEMI patients, multivessel intervention during the index PCI was associated with higher 30-day mortality (8.3% vs 6.3%, adjusted hazard ratio [HR] 1.36, 95% CI 1.14-1.62) than culprit-only intervention, and this trend persisted at 1year (13.8% vs 12.2%, adjusted HR 1.14, 95% CI 0.99-1.31). No significant mortality differences were observed among NSTEMI patients at 30days (3.4% vs 4.1%, adjusted HR 1.01, 95% CI 0.88-1.15) or at 1year (10.1% vs 10.8%, adjusted HR 0.99, 95% CI 0.91-1.08). CONCLUSIONS: Nonculprit intervention during the index PCI was associated with worse outcomes among STEMI patients, but not NSTEMI patients.

Full Text

Duke Authors

Cited Authors

  • Wang, TY; McCoy, LA; Bhatt, DL; Rao, SV; Roe, MT; Resnic, FS; Cavender, MA; Messenger, JC; Peterson, ED

Published Date

  • February 2016

Published In

Volume / Issue

  • 172 /

Start / End Page

  • 9 - 18

PubMed ID

  • 26856210

Pubmed Central ID

  • 26856210

Electronic International Standard Serial Number (EISSN)

  • 1097-6744

Digital Object Identifier (DOI)

  • 10.1016/j.ahj.2015.10.017

Language

  • eng

Conference Location

  • United States