EuroIntervention PCRonline - Connecting with the community

CORONARY INTERVENTIONS

Complete or incomplete coronary revascularisation in patients with myocardial infarction and multivessel disease: a propensity score analysis from the “real-life” BleeMACS (Bleeding complications in a Multicenter registry of patients discharged with diagnosis of Acute Coronary Syndrome) registry

1. Dipartimento di Scienze Mediche, Divisione di Cardiologia, Città della Salute e della Scienza, Turin, Italy; 2. University Hospital Álvaro Cunqueiro, Vigo, Spain; 3. University Academic Medical Center, Amsterdam, the Netherlands; 4. NorthShore University Hospital, Chicago, IL, USA; 5. University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain; 6. Libin Cardiovascular Institute of Alberta, Calgary, Canada; 7. San Carlos Hospital, Madrid, Spain; 8. Bellvitge Hospital, Barcelona, Spain; 9. Beijing Anzhen Hospital, Capital Medical University, Beijing, China; 10. University Patras Hospital, Athens, Greece; 11. Kerckhoff Heart and Thorax Center, Frankfurt, Germany; 12. University Clinical Hospital, Kyoto, Japan; 13. University Clinical Hospital, Warsaw, Poland; 14. Institute of Heart, Lung and Blood Vessel Disease, Beijing, China; 15. Tokai University School of Medicine, Tokyo, Japan; 16. Hospital Sao Rafael, Salvador, Brazil; 17. Division of Cardiovascular Medicine, Kanazawa University Graduate School of Medicine, Kanazawa, Japan; 18. University Clinic of Cardiology, Skopje, Former Yugoslav Republic of Macedonia (FYROM); 19. Division of Cardiology, Degli Infermi Hospital, Rivoli, Turin, Italy

Aims: The benefit of complete or incomplete percutaneous coronary intervention (PCI) in patients with myocardial infarction and multivessel disease remains debated. The aim of our study was to compare a complete vs. a “culprit only” revascularisation strategy in patients with myocardial infarction distinguishing the different clinical subsets (STEMI and NSTEMI) and to provide one-year clinical outcome from the “real-life” BleeMACS (Bleeding complications in a Multicenter registry of patients discharged with diagnosis of Acute Coronary Syndrome) registry.

Methods and results: We conducted a multicentre study including all patients with myocardial infarction and multivessel coronary disease included in the BleeMACS (Bleeding complications in a Multicenter registry of patients discharged with diagnosis of Acute Coronary Syndrome) registry. They were divided into two groups, complete revascularisation (CR) and incomplete revascularisation (IR). The primary endpoint was the death rate at one-year follow-up. Secondary endpoints were in-hospital repeat myocardial infarction (re-AMI), in-hospital heart failure (HF), major adverse cardiovascular events (MACE) and myocardial infarction at one year. Four thousand five hundred and twenty patients were included in our analysis, with a diagnosis of STEMI in 67.7% and NSTEMI in 32.3%. CR was performed in 27.2% and 42.4%, respectively. At univariate analysis, in-hospital and one-year outcomes were similar between CR and IR in STEMI patients (all p-values >0.05). In NSTEMI patients, CR was associated with a lower one-year death rate (4.5% vs. 8.5%; p=0.002), re-AMI (3.7% vs. 6.6%; p=0.016) and MACE (8.1% vs. 13.9%; p=0.001). After propensity score matching, CR also reduced events in STEMI patients, including one-year mortality (5.3% vs. 13.8%; p<0.001), re-AMI (4.9% vs. 17.4%; p<0.001) and MACE (8.5% vs. 24.6%; p<0.001).

Conclusions: This multicentre retrospective registry showed the benefit of CR in terms of reduction of one-year mortality in patients with myocardial reinfarction and multivessel coronary disease. Randomised controlled trials including functional evaluation of the lesions should be performed to confirm our results.

– OR –