Clinical InvestigationMultivessel vs culprit-only percutaneous coronary intervention among patients 65 years or older with acute myocardial infarction
Section snippets
Study population
The CathPCI Registry, an initiative of the ACC and the Society for Cardiovascular Angiography and Interventions, is the largest US clinical registry of patients undergoing diagnostic cardiac catheterization and PCI. Details of the CathPCI Registry have been previously described.13 In brief, trained data abstractors at each participating hospital collect detailed baseline clinical characteristics, in-hospital care processes, and outcomes retrospectively via medical record review using a
Hospital and patient characteristics
Among patients 65 years or older with acute MI and multivessel disease treated with PCI, most (17,514 STEMI [91%] and 23,344 NSTEMI [74%] patients) underwent culprit-only intervention during the index PCI procedure.
Baseline hospital and patient characteristics comparing patients who underwent culprit-only vs multivessel intervention during the index PCI procedure are presented in Table I. Multivessel intervention during the index PCI for STEMI was more often performed in rural communities or
Discussion
Several insights emerge from this large retrospective study of patients 65 years or older undergoing PCI for an acute MI. A non–infarct-related vessel was treated during the index PCI procedure in approximately 1 in 10 STEMI patients and 1 in 4 NSTEMI patients with multivessel disease. Among STEMI patients, multivessel intervention during the index PCI procedure was associated with higher short-term mortality, but no significant difference in long-term mortality compared with culprit-only PCI.
Conclusions
To our knowledge, this is the largest study of older patients presenting with acute MI and multivessel coronary artery disease. We observed most patients to undergo culprit-only intervention during the index PCI. Multivessel intervention during the index procedure was associated with higher 30-day mortality among STEMI patients, and there were no significant differences in long-term mortality among both STEMI and NSTEMI patients when compared with culprit-only PCI.
Disclosures
Dr Wang reports research grants to the DCRI from Eli Lilly, Daiichi Sankyo, Gilead Sciences, Glaxo Smith Kline, the American College of Cardiology, and the American Society of Nuclear Cardiology, as well as honoraria from Astra Zeneca and the American College of Cardiology. Ms McCoy, Dr Rao, Dr Resnic, Dr Cavender, and Dr Messenger have no relevant disclosures to report. Dr Bhatt discloses the following relationships: advisory board: Cardax, Elsevier Practice Update Cardiology, Medscape
Acknowledgements
The authors would like to thank Erin Hanley, MS, for her editorial contributions to this manuscript. Ms Hanley did not receive compensation for her assistance, apart from her employment at the institution where this study was conducted.
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Alice K. Jacobs, MD served as guest editor for this article.