Multivessel Versus Culprit-Vessel Percutaneous Coronary Intervention in Patients With Non–ST-Segment Elevation Myocardial Infarction and Cardiogenic Shock

Mohamed A. Omer; Emmanouil S. Brilakis; Kevin F. Kennedy; Mohamad Alkhouli; Islam Y. Elgendy; Paul S. Chan; John A. Spertus

doi:10.1016/j.jcin.2021.02.021

Multivessel Versus Culprit-Vessel Percutaneous Coronary Intervention in Patients With Non–ST-Segment Elevation Myocardial Infarction and Cardiogenic Shock

Mohamed A. Omer
, Emmanouil S. Brilakis
, Kevin F. Kennedy
, Mohamad Alkhouli
, Islam Y. Elgendy
, Paul S. Chan
, John A. Spertus

Research output: Contribution to journal › Article › peer-review

34 Scopus citations

Abstract

Objectives: The aim of this study was to compare in-hospital outcomes and long-term mortality of multivessel versus culprit vessel–only percutaneous coronary intervention (PCI) in patients with non–ST-segment elevation myocardial infarction (NSTEMI), multivessel disease (MVD) and cardiogenic shock. Background: The clinical benefits of complete revascularization in patients with NSTEMI, MVD, and cardiogenic shock remain uncertain. Methods: Among 25,324 patients included in the National Cardiovascular Data Registry CathPCI Registry from July 2009 to March 2018, the rates of in-hospital procedural outcomes were compared between those undergoing multivessel PCI and those undergoing culprit vessel–only PCI after 1:1 propensity score matching. Among patients aged ≥65 years matched to the Centers for Medicare and Medicaid Services database, long-term mortality was compared using proportional hazards analysis. Results: Multivessel PCI was performed in 9,791 patients (38.7%), which increased from 32.2% in 2010 to 44.2% in 2017 (p for trend <0.001). After 1:1 propensity matching (n = 7,864 in each group), those undergoing multivessel PCI had a 3.5% (95% confidence interval [CI]: 2.0% to 5.0%) lower absolute rate of in-hospital mortality (30.9% vs. 34.4%; p < 0.001; odds ratio [OR]: 0.85; 95% CI: 0.80 to 0.91), but a higher risk for bleeding (13.2% vs. 10.8%; p < 0.001; OR: 1.26; 95% CI: 1.15 to 1.40) and new requirement for dialysis (5.7% vs. 4.6%; p = 0.001; OR: 1.26; 95% CI: 1.10 to 1.46). Among those surviving to discharge, all-cause mortality was similar through 7 years (conditional hazard ratio: 0.95; 95% CI: 0.87 to 1.03; p = 0.20). Conclusions: Nearly 40% of patients with NSTEMI with MVD and cardiogenic shock underwent multivessel PCI, which was associated with lower in-hospital mortality but greater peri-procedural complications. Among those surviving to discharge, multivessel PCI did not confer additional long-term mortality benefit.

Original language	English
Pages (from-to)	1067-1078
Number of pages	12
Journal	JACC: Cardiovascular Interventions
Volume	14
Issue number	10
DOIs	https://doi.org/10.1016/j.jcin.2021.02.021
State	Published - May 24 2021

Bibliographical note

Publisher Copyright:
© 2021 American College of Cardiology Foundation

Funding

Dr. Brilkais has received consulting and speaker honoraria from Abbott Vascular, the American Heart Association (associate editor, Circulation), Amgen, Biotronik, Boston Scientific, the Cardiovascular Innovations Foundation (Board of Directors), ControlRad, CSI, Ebix, Elsevier, GE Healthcare, InfraRedx, Medtronic, Siemens, and Teleflex; has received research support from Regeneron and Siemens; is an owner of Hippocrates; and is a shareholder in MHI Ventures. Dr. Chan is supported by a grant from the National Heart, Lung, and Blood Institute (1R01HL123980). Dr. Spertus has received grant funding from the National Institutes of Health, the Patient-Centered Outcomes Research Institute, Abbott Vascular, and Bayer; has equity interest in Health Outcomes Sciences; has a copyright to the Seattle Angina Questionnaire; and has served as a consultant to Novartis, Bayer, United Healthcare, and AstraZeneca. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Funders	Funder number
National Institutes of Health (NIH)
National Heart, Lung, and Blood Institute (NHLBI)	R01HL123980
AstraZeneca
Patient-Centered Outcomes Research Institute
Abbott Vascular
Bayer Fund

Keywords

cardiogenic shock
culprit vessel
multivessel
NSTEMI

ASJC Scopus subject areas

Cardiology and Cardiovascular Medicine

Access to Document

10.1016/j.jcin.2021.02.021

Cite this

@article{da64f8eebadc438a9ecbfef21f89f003,

title = "Multivessel Versus Culprit-Vessel Percutaneous Coronary Intervention in Patients With Non–ST-Segment Elevation Myocardial Infarction and Cardiogenic Shock",

abstract = "Objectives: The aim of this study was to compare in-hospital outcomes and long-term mortality of multivessel versus culprit vessel–only percutaneous coronary intervention (PCI) in patients with non–ST-segment elevation myocardial infarction (NSTEMI), multivessel disease (MVD) and cardiogenic shock. Background: The clinical benefits of complete revascularization in patients with NSTEMI, MVD, and cardiogenic shock remain uncertain. Methods: Among 25,324 patients included in the National Cardiovascular Data Registry CathPCI Registry from July 2009 to March 2018, the rates of in-hospital procedural outcomes were compared between those undergoing multivessel PCI and those undergoing culprit vessel–only PCI after 1:1 propensity score matching. Among patients aged ≥65 years matched to the Centers for Medicare and Medicaid Services database, long-term mortality was compared using proportional hazards analysis. Results: Multivessel PCI was performed in 9,791 patients (38.7\%), which increased from 32.2\% in 2010 to 44.2\% in 2017 (p for trend <0.001). After 1:1 propensity matching (n = 7,864 in each group), those undergoing multivessel PCI had a 3.5\% (95\% confidence interval [CI]: 2.0\% to 5.0\%) lower absolute rate of in-hospital mortality (30.9\% vs. 34.4\%; p < 0.001; odds ratio [OR]: 0.85; 95\% CI: 0.80 to 0.91), but a higher risk for bleeding (13.2\% vs. 10.8\%; p < 0.001; OR: 1.26; 95\% CI: 1.15 to 1.40) and new requirement for dialysis (5.7\% vs. 4.6\%; p = 0.001; OR: 1.26; 95\% CI: 1.10 to 1.46). Among those surviving to discharge, all-cause mortality was similar through 7 years (conditional hazard ratio: 0.95; 95\% CI: 0.87 to 1.03; p = 0.20). Conclusions: Nearly 40\% of patients with NSTEMI with MVD and cardiogenic shock underwent multivessel PCI, which was associated with lower in-hospital mortality but greater peri-procedural complications. Among those surviving to discharge, multivessel PCI did not confer additional long-term mortality benefit.",

keywords = "cardiogenic shock, culprit vessel, multivessel, NSTEMI",

author = "Omer, \{Mohamed A.\} and Brilakis, \{Emmanouil S.\} and Kennedy, \{Kevin F.\} and Mohamad Alkhouli and Elgendy, \{Islam Y.\} and Chan, \{Paul S.\} and Spertus, \{John A.\}",

note = "Publisher Copyright: {\textcopyright} 2021 American College of Cardiology Foundation",

year = "2021",

month = may,

day = "24",

doi = "10.1016/j.jcin.2021.02.021",

language = "English",

volume = "14",

pages = "1067--1078",

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}

Multivessel Versus Culprit-Vessel Percutaneous Coronary Intervention in Patients With Non–ST-Segment Elevation Myocardial Infarction and Cardiogenic Shock. / Omer, Mohamed A.; Brilakis, Emmanouil S.; Kennedy, Kevin F. et al.
In: JACC: Cardiovascular Interventions, Vol. 14, No. 10, 24.05.2021, p. 1067-1078.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Multivessel Versus Culprit-Vessel Percutaneous Coronary Intervention in Patients With Non–ST-Segment Elevation Myocardial Infarction and Cardiogenic Shock

AU - Omer, Mohamed A.

AU - Brilakis, Emmanouil S.

AU - Kennedy, Kevin F.

AU - Alkhouli, Mohamad

AU - Elgendy, Islam Y.

AU - Chan, Paul S.

AU - Spertus, John A.

PY - 2021/5/24

Y1 - 2021/5/24

N2 - Objectives: The aim of this study was to compare in-hospital outcomes and long-term mortality of multivessel versus culprit vessel–only percutaneous coronary intervention (PCI) in patients with non–ST-segment elevation myocardial infarction (NSTEMI), multivessel disease (MVD) and cardiogenic shock. Background: The clinical benefits of complete revascularization in patients with NSTEMI, MVD, and cardiogenic shock remain uncertain. Methods: Among 25,324 patients included in the National Cardiovascular Data Registry CathPCI Registry from July 2009 to March 2018, the rates of in-hospital procedural outcomes were compared between those undergoing multivessel PCI and those undergoing culprit vessel–only PCI after 1:1 propensity score matching. Among patients aged ≥65 years matched to the Centers for Medicare and Medicaid Services database, long-term mortality was compared using proportional hazards analysis. Results: Multivessel PCI was performed in 9,791 patients (38.7%), which increased from 32.2% in 2010 to 44.2% in 2017 (p for trend <0.001). After 1:1 propensity matching (n = 7,864 in each group), those undergoing multivessel PCI had a 3.5% (95% confidence interval [CI]: 2.0% to 5.0%) lower absolute rate of in-hospital mortality (30.9% vs. 34.4%; p < 0.001; odds ratio [OR]: 0.85; 95% CI: 0.80 to 0.91), but a higher risk for bleeding (13.2% vs. 10.8%; p < 0.001; OR: 1.26; 95% CI: 1.15 to 1.40) and new requirement for dialysis (5.7% vs. 4.6%; p = 0.001; OR: 1.26; 95% CI: 1.10 to 1.46). Among those surviving to discharge, all-cause mortality was similar through 7 years (conditional hazard ratio: 0.95; 95% CI: 0.87 to 1.03; p = 0.20). Conclusions: Nearly 40% of patients with NSTEMI with MVD and cardiogenic shock underwent multivessel PCI, which was associated with lower in-hospital mortality but greater peri-procedural complications. Among those surviving to discharge, multivessel PCI did not confer additional long-term mortality benefit.

AB - Objectives: The aim of this study was to compare in-hospital outcomes and long-term mortality of multivessel versus culprit vessel–only percutaneous coronary intervention (PCI) in patients with non–ST-segment elevation myocardial infarction (NSTEMI), multivessel disease (MVD) and cardiogenic shock. Background: The clinical benefits of complete revascularization in patients with NSTEMI, MVD, and cardiogenic shock remain uncertain. Methods: Among 25,324 patients included in the National Cardiovascular Data Registry CathPCI Registry from July 2009 to March 2018, the rates of in-hospital procedural outcomes were compared between those undergoing multivessel PCI and those undergoing culprit vessel–only PCI after 1:1 propensity score matching. Among patients aged ≥65 years matched to the Centers for Medicare and Medicaid Services database, long-term mortality was compared using proportional hazards analysis. Results: Multivessel PCI was performed in 9,791 patients (38.7%), which increased from 32.2% in 2010 to 44.2% in 2017 (p for trend <0.001). After 1:1 propensity matching (n = 7,864 in each group), those undergoing multivessel PCI had a 3.5% (95% confidence interval [CI]: 2.0% to 5.0%) lower absolute rate of in-hospital mortality (30.9% vs. 34.4%; p < 0.001; odds ratio [OR]: 0.85; 95% CI: 0.80 to 0.91), but a higher risk for bleeding (13.2% vs. 10.8%; p < 0.001; OR: 1.26; 95% CI: 1.15 to 1.40) and new requirement for dialysis (5.7% vs. 4.6%; p = 0.001; OR: 1.26; 95% CI: 1.10 to 1.46). Among those surviving to discharge, all-cause mortality was similar through 7 years (conditional hazard ratio: 0.95; 95% CI: 0.87 to 1.03; p = 0.20). Conclusions: Nearly 40% of patients with NSTEMI with MVD and cardiogenic shock underwent multivessel PCI, which was associated with lower in-hospital mortality but greater peri-procedural complications. Among those surviving to discharge, multivessel PCI did not confer additional long-term mortality benefit.

KW - cardiogenic shock

KW - culprit vessel

KW - multivessel

KW - NSTEMI

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Multivessel Versus Culprit-Vessel Percutaneous Coronary Intervention in Patients With Non–ST-Segment Elevation Myocardial Infarction and Cardiogenic Shock

Abstract

Bibliographical note

Funding

Keywords

ASJC Scopus subject areas

Access to Document

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