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Culprit-only or multivessel revascularization in patients with acute coronary syndromes: an American College of Cardiology National Cardiovascular Database Registry report.

Publication ,  Journal Article
Brener, SJ; Milford-Beland, S; Roe, MT; Bhatt, DL; Weintraub, WS; Brindis, RG ...
Published in: Am Heart J
January 2008

BACKGROUND: Multivessel (MV) coronary artery disease (CAD) frequently exists in patients presenting with non-ST-elevation (NSTE) acute coronary syndromes (ACSs). Although an early invasive strategy improves outcome in these patients, there are limited data on culprit-only, single-vessel (SV) percutaneous coronary intervention (PCI) or MV PCI in the NSTE ACS setting. METHODS: To identify the predictors of SV versus MV PCI in patients with ACS and compare their outcomes up to hospital discharge, we analyzed the records of 105,866 patients undergoing PCI with ACS and MV CAD from 402 centers reported to the American College of Cardiology National Cardiovascular Database Registry between 2000 and 2004. Demographic, clinical, and angiographic characteristics of the patients were used to create a propensity score for SV versus MV PCI. RESULTS: Single-vessel PCI was performed in 68% (72,048 patients), whereas the remaining 32% (33,818 patients) had MV PCI. Factors independently associated with the performance of SV versus MV PCI were presentation with NSTE infarction (vs unstable angina), adjusted odds ratio (OR) of 1.29 (95% CI 1.24-1.34); being older, adjusted OR of 1.09 (95% CI 1.08-1.11) per decade; and presence of total occlusion, adjusted OR of 1.25 (95% CI 1.16-1.36). The c-statistic for the model was 0.70. Procedural success was achieved in 91% of SV PCI and 88% of MV PCI (P < .001). Inhospital mortality was 1.3% and 1.2%, respectively (P = .09; adjusted OR 1.11 [95% CI 0.97-1.27], P = .13). Rates of morbidity, such as bleeding, development of renal failure, or nonfatal cardiogenic shock, were similar for both groups. CONCLUSIONS: In patients with MV CAD, presenting with ACS and selected for PCI, performance of MV PCI appears to be associated with at least as successful an inhospital outcome as SV PCI.

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Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

January 2008

Volume

155

Issue

1

Start / End Page

140 / 146

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Survival Rate
  • Risk Assessment
  • Registries
  • Probability
  • Patient Selection
  • Odds Ratio
  • Myocardial Revascularization
  • Middle Aged
 

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Brener, S. J., Milford-Beland, S., Roe, M. T., Bhatt, D. L., Weintraub, W. S., Brindis, R. G., & American College of Cardiology National Cardiovascular Database Registry, . (2008). Culprit-only or multivessel revascularization in patients with acute coronary syndromes: an American College of Cardiology National Cardiovascular Database Registry report. Am Heart J, 155(1), 140–146. https://doi.org/10.1016/j.ahj.2007.09.007
Brener, Sorin J., Sarah Milford-Beland, Matthew T. Roe, Deepak L. Bhatt, William S. Weintraub, Ralph G. Brindis, and Ralph G. American College of Cardiology National Cardiovascular Database Registry. “Culprit-only or multivessel revascularization in patients with acute coronary syndromes: an American College of Cardiology National Cardiovascular Database Registry report.Am Heart J 155, no. 1 (January 2008): 140–46. https://doi.org/10.1016/j.ahj.2007.09.007.
Brener SJ, Milford-Beland S, Roe MT, Bhatt DL, Weintraub WS, Brindis RG, et al. Culprit-only or multivessel revascularization in patients with acute coronary syndromes: an American College of Cardiology National Cardiovascular Database Registry report. Am Heart J. 2008 Jan;155(1):140–6.
Brener, Sorin J., et al. “Culprit-only or multivessel revascularization in patients with acute coronary syndromes: an American College of Cardiology National Cardiovascular Database Registry report.Am Heart J, vol. 155, no. 1, Jan. 2008, pp. 140–46. Pubmed, doi:10.1016/j.ahj.2007.09.007.
Brener SJ, Milford-Beland S, Roe MT, Bhatt DL, Weintraub WS, Brindis RG, American College of Cardiology National Cardiovascular Database Registry. Culprit-only or multivessel revascularization in patients with acute coronary syndromes: an American College of Cardiology National Cardiovascular Database Registry report. Am Heart J. 2008 Jan;155(1):140–146.
Journal cover image

Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

January 2008

Volume

155

Issue

1

Start / End Page

140 / 146

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Survival Rate
  • Risk Assessment
  • Registries
  • Probability
  • Patient Selection
  • Odds Ratio
  • Myocardial Revascularization
  • Middle Aged