Multivessel percutaneous coronary intervention in patients with acute myocardial infarction and severe renal dysfunction.

Abstract

The aim of this study was to compare the outcomes between multivessel and infarct-related artery (IRA)-only percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI), multivessel disease (MVD), and severe renal dysfunction (RD) using the nationwide AMI registry. Among 13,104 patients, 537 diagnosed with AMI and MVD who had severe RD at presentation (estimated glomerular filtration rate [GFR] <30 mL/min/1.73 m2, mean: 19.1±7.5 mL/min/1.73 m2) and underwent PCI during index hospitalisation were selected. The patients were classified according to treatment strategy, i.e., multivessel PCI (49.0%) or IRA-only PCI. The primary endpoint was major adverse cardiac events (MACE), a composite of all-cause death, myocardial reinfarction, re-hospitalisation for heart failure, and any repeat revascularisation at one year. The safety outcome was the worsening of renal function (WRF), defined as a 30% reduction in estimated GFR from baseline to 12-month follow-up. The adjusted MACE risks were similar in groups after Cox regression (41.8% vs 39.8%, hazard ratio [HR] 1.008 [0.743-1.367]) and propensity score-matching analysis (HR 0.974 [0.651-1.377]). Multivessel PCI showed a significant tendency of higher rates of WRF (24.8% vs 11.1%, adjusted odds ratio 2.134 [0.976-4.668]). Multivessel PCI was associated with similar outcomes compared to IRA-only PCI in patients with AMI, MVD, and severe RD.