Abstract
Introduction: Current recommendations based largely on observational data state that multi-vessel percutaneous coronary intervention (MVPCI) in STEMI at time of initial hospitalization may be harmful. Hypothesis: MVPCI is not associated with higher in-hospital mortality in a large contemporary national dataset, and has never been. Methods: We queried the Nationwide Inpatient Sample (NIS) which includes in-hospital outcomes for 20% of all hospitalizations across US to identify mortality associated with MV-PCI for STEMI in unadjusted, multi-variable and propensity adjusted models. Published observational studies comparing in-hospital mortality with MV-PCI in contrast with infarct-related artery (IRA) only PCI were also pooled. Odds ratios (OR) and respective 95% confidence intervals (CI) were reported in a random effects model. Results were validated with study sequential analyses. Results: From 2009-2012-there were 11,454 MVPCI and 157,011 single-vessel PCI (SVPCI) for STEMI patients in the NIS. Mortality was 1.91% for MVPCI Vs 8.9% for SVPCI in the unadjusted analysis (OR 0.20, 95% CI 0.17-0.23). In a multivariable model(OR 0.28, 95% CI 0.24-0.33) and 1:3 propensity matched model (1.91% vs. 5.32%, OR 0.28, 95% CI 0.24-0.32)results were similar. Our analysis of index hospitalization MVPCI versus infarct-related artery (IRA) - only PCI in the comprehensive meta-analysis of observational studies (19 studies, N=76,399), demonstrated no difference in in-hospital mortality with MVPCI (5.3%) compared with IRA-only PCI (5.06%)(OR 0.87, 95% CI 0.65-1.17; p=0.37).Study sequential analyses confirmed our results.(Figure) Conclusion: MVPCI is very rarely performed on the index hospitalization in a contemporary cohort of STEMI patients in the US reflecting adherence to current guidelines. Based on all available observational data, there does not appear to be early harm associated with MVPCI in STEMI.
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