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

Publication ,  Journal Article
Toma, M; Buller, CE; Westerhout, CM; Fu, Y; O'Neill, WW; Holmes, DR; Hamm, CW; Granger, CB; Armstrong, PW; APEX-AMI Investigators,
Published in: Eur Heart J
July 2010

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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Published In

Eur Heart J

DOI

EISSN

1522-9645

Publication Date

July 2010

Volume

31

Issue

14

Start / End Page

1701 / 1707

Location

England

Related Subject Headings

  • Young Adult
  • Shock, Cardiogenic
  • Randomized Controlled Trials as Topic
  • Propensity Score
  • Prognosis
  • Myocardial Infarction
  • Multicenter Studies as Topic
  • Middle Aged
  • Male
  • Kaplan-Meier Estimate
 

Citation

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Toma, M., Buller, C. E., Westerhout, C. M., Fu, Y., O’Neill, W. W., Holmes, D. R., … APEX-AMI Investigators, . (2010). Non-culprit coronary artery percutaneous coronary intervention during acute ST-segment elevation myocardial infarction: insights from the APEX-AMI trial. Eur Heart J, 31(14), 1701–1707. https://doi.org/10.1093/eurheartj/ehq129
Toma, Mustafa, Christopher E. Buller, Cynthia M. Westerhout, Yuling Fu, William W. O’Neill, David R. Holmes, Christian W. Hamm, Christopher B. Granger, Paul W. Armstrong, and Paul W. APEX-AMI Investigators. “Non-culprit coronary artery percutaneous coronary intervention during acute ST-segment elevation myocardial infarction: insights from the APEX-AMI trial.Eur Heart J 31, no. 14 (July 2010): 1701–7. https://doi.org/10.1093/eurheartj/ehq129.
Toma M, Buller CE, Westerhout CM, Fu Y, O’Neill WW, Holmes DR, et al. Non-culprit coronary artery percutaneous coronary intervention during acute ST-segment elevation myocardial infarction: insights from the APEX-AMI trial. Eur Heart J. 2010 Jul;31(14):1701–7.
Toma, Mustafa, et al. “Non-culprit coronary artery percutaneous coronary intervention during acute ST-segment elevation myocardial infarction: insights from the APEX-AMI trial.Eur Heart J, vol. 31, no. 14, July 2010, pp. 1701–07. Pubmed, doi:10.1093/eurheartj/ehq129.
Toma M, Buller CE, Westerhout CM, Fu Y, O’Neill WW, Holmes DR, Hamm CW, Granger CB, Armstrong PW, APEX-AMI Investigators. Non-culprit coronary artery percutaneous coronary intervention during acute ST-segment elevation myocardial infarction: insights from the APEX-AMI trial. Eur Heart J. 2010 Jul;31(14):1701–1707.
Journal cover image

Published In

Eur Heart J

DOI

EISSN

1522-9645

Publication Date

July 2010

Volume

31

Issue

14

Start / End Page

1701 / 1707

Location

England

Related Subject Headings

  • Young Adult
  • Shock, Cardiogenic
  • Randomized Controlled Trials as Topic
  • Propensity Score
  • Prognosis
  • Myocardial Infarction
  • Multicenter Studies as Topic
  • Middle Aged
  • Male
  • Kaplan-Meier Estimate