Long-Term Safety and Efficacy of Staged Percutaneous Coronary Intervention for Patients with ST-Segment Elevation Myocardial Infarction and Multivessel Coronary Disease

Cui, Kongyong; Lyu, Shuzheng; Song, Xiaoyan; Liu, Hong; Yuan, Fei; Xu, Feng; Zhang, Min; Wang, Wei; Zhang, Mingduo; Zhang, Dongfeng; Tian, Jinfan

doi:10.1016/j.amjcard.2019.04.048

Cited by 16 publications

(19 citation statements)

References 23 publications

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“…3 PPCI therapy can rescue blocked blood vessels in time, restore myocardial blood perfusion, and significantly reduce the mortality and recurrence rates of infarction. 4 Current guidelines recommend routine anticoagulation during PPCI in patients with STEMI. 5 In addition to the treatment strategy and standard operation, the efficacy and safety of anticoagulant drugs in PPCI are important for a successful operation.…”

Section: Introductionmentioning

confidence: 99%

Efficacy and safety of bivalirudin application during primary percutaneous coronary intervention in older patients with acute ST-segment elevation myocardial infarction

Chen

Kong

et al. 2020

J Int Med Res

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Objective ST-segment elevation myocardial infarction (STEMI) is the most serious type of acute coronary syndrome. This study aimed to investigate the efficacy and safety of bivalirudin application during primary percutaneous coronary intervention (PPCI) in older patients with acute STEMI. Methods A total of 672 older patients with STEMI (>75 years) who underwent PPCI were studied. The primary endpoints were 30-day net adverse clinical events (NACEs) post-emergency percutaneous coronary intervention, including major adverse cardiac and cerebrovascular events (MACCEs) and Bleeding Academic Research Consortium grades 2 to 5 (BARC 2–5) bleeding events. Results The incidence of NACEs and BARC 2–5 bleeding events in the bivalirudin group was significantly lower than that in the unfractionated heparin group. Multivariate Cox regression analysis showed that bivalirudin significantly reduced 30-day NACEs (odds ratio: 0.700, 95% confidence interval: 0.492–0.995) and BARC 2–5 bleeding events (odds ratio: 0.561, 95% confidence interval: 0.343–0.918). At 1-year follow-up, these results were similar. Conclusions Bivalirudin can be safely and effectively used during PPCI in older patients with STEMI. Bivalirudin reduces the risks of NACEs and bleeding within 30 days after PPCI, without increasing the risks of MACCEs and stent thrombosis compared with heparin.

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Section: Introductionmentioning

confidence: 99%

Efficacy and safety of bivalirudin application during primary percutaneous coronary intervention in older patients with acute ST-segment elevation myocardial infarction

Chen

Kong

et al. 2020

J Int Med Res

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“…In addition, the Third DANish Study of Optimal Acute Treatment of Patients with STEMI-PRImary PCI in MULTIvessel Disease and the Compare-Acute trials indicated significant benefit of immediate or complete revascularization regarding adverse cardiac events compared with culprit-only PCI [11, 12]. Furthermore, the studies conducted by Cui et al and Toyota et al with 5-year information confirmed and extended the results of previous studies with short- or medium-term follow-up period [24, 30].…”

Section: Discussionmentioning

confidence: 58%

“…The present report is a single-center, retrospective, observational study. The study design has been previously described [24]. Briefly, a total of 1205 patients with STEMI and multivessel disease who underwent primary PCI within 12 h from symptom onset underwent staged complete revascularization or culprit-only PCI between January 2006 and December 2015 in our center.…”

Section: Methodsmentioning

confidence: 99%

Staged complete revascularization or culprit-only percutaneous coronary intervention for multivessel coronary artery disease in patients with ST-segment elevation myocardial infarction and diabetes

Cui

Lyu

Hong

et al. 2019

Cardiovasc Diabetol

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Background Recently, several randomized trials have noted improved outcomes with staged percutaneous coronary intervention (PCI) of nonculprit vessels in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease. However, it remains unclear whether diabetes status affects the outcomes after different revascularization strategies. This study thus compared the impact of diabetes status on long-term outcomes after staged complete revascularization with that after culprit-only PCI. Methods From January 2006 to December 2015, 371 diabetic patients (staged PCI: 164, culprit-only PCI: 207) and 834 nondiabetic patients (staged PCI: 412, culprit-only PCI: 422) with STEMI and multivessel disease were enrolled. The primary endpoint was 5-year major adverse cardiac and cerebrovascular event (MACCE), defined as a composite of all-cause death, myocardial infarction (MI), stroke or unplanned revascularization. Results The rate of the 5-year composite primary endpoint for diabetic patients was close to that for nondiabetic patients (34.5% vs. 33.7%; adjusted hazard ratio [HR] 1.012, 95% confidence interval [CI] 0.815–1.255). In nondiabetic patients, the 5-year risks of MACCE (31.8% vs. 35.5%; adjusted HR 0.638, 95% CI 0.500–0.816), MI (4.6% vs. 9.2%; adjusted HR 0.358, 95% CI 0.200–0.641), unplanned revascularization (19.9% vs. 24.9%; adjusted HR 0.532, 95% CI 0.393–0.720), and the composite of cardiac death, MI or stroke (11.4% vs. 15.2%; adjusted HR 0.621, 95% CI 0.419–0.921) were significantly lower after staged PCI than after culprit-only PCI. In contrast, no significant difference was found between the two groups with respect to MACCE, MI, unplanned revascularization, and the composite of cardiac death, MI or stroke in diabetic patients. Significant interactions were found between diabetes status and revascularization assignment for the composite of cardiac death, MI or stroke (Pinteraction = 0.013), MI (Pinteraction = 0.005), and unplanned revascularization (Pinteraction = 0.013) at 5 years. In addition, the interaction tended to be significant for the primary endpoint of MACCE (Pinteraction = 0.053). Moreover, the results of propensity score-matching analysis were concordant with the overall analysis in both diabetic and nondiabetic population. Conclusions In patients with STEMI and multivessel disease, diabetes is not an independent predictor of adverse cardiovascular events at 5 years. In nondiabetic patients, an approach of staged complete revascularization is superior to culprit-only PCI, whereas the advantage of staged PCI is attenuated in diabetic patients. Trial registration This study was not registered in an open access database

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“…The staged procedure was done within 30 days of primary PCI and after propensity matching of patients, had lower incidence of MACCE. However, the same study failed to demonstrate the benefit of this strategy for diabetic patients [16].The registry by Hannah et al has demonstrated a benefit in terms of reduced mortality at 12 months for staged PCI within 60 days after initial primary PCI compared to culprit only PCI within the initial hospitalization. The study also demonstrated increased in-hospital mortality for multivessel PCI at the initial procedure [6].…”

Section: Discussionmentioning

confidence: 99%

A complete versus inducible ischemia-guided revascularization after a culprit-only primary percutaneous coronary intervention in multivessel coronary artery disease: A pilot study

et al. 2021

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Introduction/Objective. Revascularization in multivessel coronary artery disease (MVD) in patients with ST elevation myocardial infarction (STEMI) is a matter of debate. We sought to compare outcomes between revascularization strategies based on angiographic lesion severity or inducible ischemia. Methods. In prospective study, first ever STEMI patients with MVD, defined as > 70% stenosis in non-culprit vessel, treated with culprit only primary PCI were randomized to: A. Complete revascularization of all non-culprit significant lesions during initial hospitalization; B. Complete revascularization after 30 days, or C. Revascularization based on non-invasive testing for inducible ischemia. The study explored occurrence of major adverse cardio-cerebral events (MACCE) (cardiac death, repeated MI, cerebrovascular event). Results. The study enrolled 120 patients with door to balloon time within appropriate limits (A 51 ? 26 vs. B 47 ? 33 vs. C 44 ? 29 min, p = 0.604) The patients in group A underwent complete revascularization at 6 [4-7] days after primary PCI, while in the group B it was 35 [32-39] days. In group C, 16/43 (37.2%) patients underwent PCI at 82 [66-147] days after infarction (p < 0.001). The patients were followed for 2.7 ? 0.8 years. The events occurred less frequently in patients that underwent planned complete revascularization compared to those who underwent ischemia testing (7.8 vs. 20.9%, p = 0.040). Kaplan-Meier analysis favored complete delayed revascularization (MACCE A 8.8 vs. B 6.9 vs. C 20.9%, log rank p = 0.041). Conclusions. Planned, angiography guided, complete revascularization after initial event may be favorable strategy compared to single stress test for multivessel coronary artery disease in STEMI.

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Long-Term Safety and Efficacy of Staged Percutaneous Coronary Intervention for Patients with ST-Segment Elevation Myocardial Infarction and Multivessel Coronary Disease

Cited by 16 publications

References 23 publications

Efficacy and safety of bivalirudin application during primary percutaneous coronary intervention in older patients with acute ST-segment elevation myocardial infarction

Efficacy and safety of bivalirudin application during primary percutaneous coronary intervention in older patients with acute ST-segment elevation myocardial infarction

Staged complete revascularization or culprit-only percutaneous coronary intervention for multivessel coronary artery disease in patients with ST-segment elevation myocardial infarction and diabetes

A complete versus inducible ischemia-guided revascularization after a culprit-only primary percutaneous coronary intervention in multivessel coronary artery disease: A pilot study

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