PMID- 20027110
OWN - NLM
STAT- MEDLINE
DCOM- 20110627
LR  - 20110311
IS  - 1536-3686 (Electronic)
IS  - 1075-2765 (Linking)
VI  - 18
IP  - 2
DP  - 2011 Mar-Apr
TI  - Coronary revascularization strategy for ST elevation myocardial infarction with 
      multivessel disease: experience and results at 1-year follow-up.
PG  - 92-100
LID - 10.1097/MJT.0b013e3181b809ee [doi]
AB  - Primary percutaneous coronary intervention (PCI) of culprit lesions (CLs) is the 
      standard of care in patients presenting with ST elevation myocardial infarction 
      (STEMI). However, optimal revascularization strategy for significant nonculprit 
      lesions (non-CLs) in the setting of STEMI remains controversial. The importance 
      of defining of such a strategy lies in the fact that approximately 50% of 
      patients with STEMI have multivessel disease (MVD). The aim of this study was to 
      describe characteristics, therapeutic strategies, and 1-year outcomes in a cohort 
      of patients with STEMI and MVD. We retrospectively analyzed a cohort of 63 
      patients with STEMI and MVD obtained from a 5-year catheterization database. MVD 
      was defined as >/=70% stenosis of >/=2 epicardial coronary arteries. This cohort was 
      followed for a period of 1 year for major adverse cardiac events (MACE was 
      defined as acute coronary syndrome, new onset heart failure, or death) and 
      all-cause mortality. PCI with stent placement was the major therapeutic procedure 
      (87.5%) performed for CLs. Non-CLs did not undergo interventions in a majority of 
      individuals (47.6%), while the remaining patients underwent PCI (29%) and 
      coronary artery bypass graft surgery (22%) for non-CLs. At 1-year follow-up, 
      prevalence of MACE events and death in the entire cohort were 30% and 15%, 
      respectively. A trend for better outcomes (1-year cumulative MACE events but not 
      mortality) was observed in CL-only intervention cohort compared with non-CL 
      intervention. The PCI and Coronary artery bypass graft surgery cohorts did not 
      show any significant difference in clinical outcomes. In this retrospective 
      cohort of patients with MVD who presented with STEMI, no intervention of 
      noncritical lesions was the prevalent approach, reflecting guideline 
      recommendations. CL-only intervention strategy showed a better clinical outcome 
      than non-CL intervention. Intervention of noncritical lesions therefore did not 
      seem to improve MACEs or all-cause mortality at 1-year of follow-up and might in 
      fact have had a detrimental effect on outcomes.
FAU - Mohamad, Tamam
AU  - Mohamad T
AD  - Division of Cardiology, Wayne State University, Harper University Hospital, 
      Detroit, MI 48201, USA. tamamns@yahoo.com
FAU - Bernal, Juan M
AU  - Bernal JM
FAU - Kondur, Ashok
AU  - Kondur A
FAU - Hari, Pawan
AU  - Hari P
FAU - Nelson, Katrina
AU  - Nelson K
FAU - Niraj, Ashutosh
AU  - Niraj A
FAU - Badheka, Apurva
AU  - Badheka A
FAU - Hassna, Samer
AU  - Hassna S
FAU - Kiernan, Tom
AU  - Kiernan T
FAU - Elder, Mahir D
AU  - Elder MD
FAU - Gardi, Delair
AU  - Gardi D
FAU - Schreiber, Theodore
AU  - Schreiber T
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Am J Ther
JT  - American journal of therapeutics
JID - 9441347
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Angioplasty, Balloon, Coronary/*methods
MH  - Cohort Studies
MH  - Coronary Artery Bypass/*methods
MH  - Coronary Stenosis/epidemiology/physiopathology/*therapy
MH  - Databases as Topic
MH  - Female
MH  - Follow-Up Studies
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Myocardial Infarction/physiopathology/surgery/*therapy
MH  - Practice Guidelines as Topic
MH  - Retrospective Studies
MH  - Stents
MH  - Treatment Outcome
EDAT- 2009/12/23 06:00
MHDA- 2011/06/28 06:00
CRDT- 2009/12/23 06:00
PHST- 2009/12/23 06:00 [entrez]
PHST- 2009/12/23 06:00 [pubmed]
PHST- 2011/06/28 06:00 [medline]
AID - 10.1097/MJT.0b013e3181b809ee [doi]
PST - ppublish
SO  - Am J Ther. 2011 Mar-Apr;18(2):92-100. doi: 10.1097/MJT.0b013e3181b809ee.