Outcomes of Different Reperfusion Strategies of Multivessel Disease Undergoing Newer-Generation Drug-Eluting Stent Implantation in Patients with Non-ST-Elevation Myocardial Infarction and Chronic Kidney Disease.

Yong Hoon Kim,Myung Ho Jeong,Byeong-Keuk Kim,Myeong-Ki Hong,Yangsoo Jang,Donghoon Choi,Seung-Jun Lee,Sung-Jin Hong,Young-Guk Ko,Ae-Young Her,Jung-Sun Kim,Chul-Min Ahn

doi:10.3390/jcm10204629

Abstract

Because available data are limited, we compared the 2-year clinical outcomes among different reperfusion strategies (culprit-only percutaneous coronary intervention (C-PCI), multivessel PCI (M-PCI), complete revascularization (CR) and incomplete revascularization (IR)) of multivessel disease (MVD) undergoing newer-generation drug-eluting stent implantation in patients with non-ST-elevation myocardial infarction (NSTEMI) and chronic kidney disease (CKD). In this nonrandomized, multicenter, retrospective cohort study, a total of 1042 patients (C-PCI, n = 470; M-PCI, n = 572; CR, n = 432; IR, n = 140) were recruited from the Korea Acute Myocardial Infarction Registry (KAMIR) and evaluated. The primary outcome was the occurrence of major adverse cardiac events, defined as all-cause death, recurrent myocardial infarction and any repeat coronary revascularization. The secondary outcome was probable or definite stent thrombosis. During the 2-year follow-up period, the cumulative incidences of the primary (C-PCI vs. M-PCI, adjusted hazard ratio (aHR), 1.020; p = 0.924; CR vs. IR, aHR, 1.012; p = 0.967; C-PCI vs. CR, aHR, 1.042; p = 0.863; or C-PCI vs. IR, aHR, 1.060; p = 0.844) and secondary outcomes were statistically insignificant in the four comparison groups. In the contemporary newer-generation DES era, C-PCI may be a better reperfusion option for patients with NSTEMI with MVD and CKD rather than M-PCI, including CR and IR, with regard to the procedure time and the risk of contrast-induced nephropathy. However, further well-designed, large-scale randomized studies are warranted to confirm these results.

Highlights

The extent of coronary artery disease (CAD) is a marker of diffuse atherosclerosis and plaque burden and multivessel disease (MVD) is associated with worse outcomes in patients with infarction (AMI) [1]
The baseline clinical, laboratory and procedural characteristics of the study population are summarized in Table 1 and Table S1
Group and the mean time interval from admission to percutaneous coronary intervention (PCI), the prescription rate of lipidlowering agent as a discharge medication, infarct-related artery (IRA) (LM) and use of intravascular ultrasound (IVUS) were significantly higher in the M-PCI group

Summary

Introduction

The extent of coronary artery disease (CAD) is a marker of diffuse atherosclerosis and plaque burden and multivessel disease (MVD) is associated with worse outcomes in patients with infarction (AMI) [1]. The incidence of MVD in patients with non-ST-segment elevation myocardial infarction (NSTEMI) is more than 50% [2,3]. Procedural complexity might lead to overexposure to radiation and an increased risk of developing contrast-induced nephropathy and further ischemia [11,12,13] in patients with AMI and MVD. After confining the study population who received newer-generation DES to reflect current real-world practice, we compared the 2-year clinical outcomes among different reperfusion strategies (culprit-only PCI (C-PCI), multivessel PCI (M-PCI), complete revascularization (CR) and incomplete revascularization (IR)) of MVD in patients with NSTEMI and CKD

Methods

Results

Conclusion