EuroIntervention PCRonline - Connecting with the community

Clinical research

Outcomes in patients undergoing multivessel percutaneous coronary intervention using sirolimus-eluting stents: a report from the e-SELECT registry

1. Oxford Heart Centre, Oxford, United Kingdom; 2. Instituto Dante Pazzanese de Cardiologia, Sao Paolo, Brazil; 3. Centro Cardiologico Monzino, IRCCS, University of Milan, Milan, Italy; 4. Cordis Clinical Research Europe, Waterloo, Belgium; 5. Peter Munk Cardiac Centre, University Health Network, Toronto, Canada; 6. Cleveland Clinic Foundation, Cleveland, OH, USA; 7. Cardiovascular Institute and Fu Wai Hospital, Beijing, China; 8. Mayo Clinic, Rochester, MN, USA; 9. The Heart Center of Chonnam National University Hospital, GwangJu, Korea; 10. Centre Hospitalier Universitaire, Liège, Belgium; 11. Herz-Zentrum Bad Krozingen, Bad Krozingen, Germany; 12. Department of Cardiology, Cochin Hospital, Assistance Publique Hôpitaux de Paris and INSERM U 970, Paris Descartes University, Paris, France; 13. Cardiovascular investigation unit Royal Adelaide Hospital, Adelaide, Australia; 14. La Tour Hospital, Geneva, Switzerland

Aims: Performing percutaneous coronary intervention (PCI) to multiple coronary lesions during the same procedure has potential economic and social advantages. However comprehensive outcome data of real world practice in a large population is limited. We aimed to compare short- and long-term outcomes between patients with multivessel coronary artery disease who either underwent single- or multivessel PCI within the e-SELECT registry.

Methods and results: The e-SELECT registry combines data collected at 320 medical centres in 56 countries where patients received CYPHER Select® or CYPHER Select® Plus sirolimus-eluting stent (SES). Rates of myocardial infarction and major adverse cardiac event (MACE) (defined as any death, myocardial infarction or target lesion revascularisation) were compared between patients undergoing single-vessel versus multivessel PCI. A total of 15,147 patients who satisfied the inclusion criteria were included in the e-SELECT registry. Two thousand two hundred and seventy-eight (2,278) subjects (15%) underwent multivessel PCI and 12,869 (85%) had single-vessel PCI. The mean age was higher in the multivessel PCI group (63 vs. 62 years, p<0.001) and there was a higher prevalence of diabetes mellitus (32.4 vs. 30.0%, p=0.02). Lesions were more complex in the single-PCI group while pre- and post-dilatation were less common in the multivessel PCI group. Myocardial infarction within the first 30 days post PCI was more common in the multivessel PCI group (1.9 vs. 0.8%, p<0.001) and most of the infarctions were periprocedural (1.3 vs. 0.6%, p=0.001). Mortality and myocardial infarction at one-year were higher in the multivessel PCI group resulting in a significantly higher MACE (6.1 vs. 4.6%, p=0.005).

Conclusions: Overall procedural and one year outcomes were excellent for both single- and multivessel procedures. However despite lower lesion complexity, performing multivessel PCI was associated with higher rates of periprocedural myocardial infarction and MACE when compared to single-vessel PCI in the e-SELECT registry.

– OR –