Effect Of Complete Revascularization Research Articles

Effects of complete revascularization according to age in patients with ST-segment elevation myocardial infarction and multivessel disease (COMPLETE-AGE)

BackgroundIn ST-segment elevation myocardial infarction (STEMI), complete revascularization with percutaneous coronary intervention (PCI) reduces major cardiovascular events compared with culprit-lesion-only PCI. Whether age influences these results remains unknown. MethodsCOMPLETE was a multinational, randomized trial evaluating a strategy of staged complete revascularization, consisting of angiography-guided PCI of all suitable non-culprit lesions, versus a strategy of culprit-lesion-only PCI. In this pre-specified subgroup analysis, treatment effect according to age (≥65 years versus <65 years) was determined for the first co-primary outcome of cardiovascular (CV) death or new myocardial infarction (MI) and the second co-primary outcome of CV death, new MI, or ischemia-driven revascularization (IDR). Median follow-up was 35.8 months (interquartile range [IQR]: 27.6 to 44.3 months). ResultsOf 4,041 patients randomized in COMPLETE, 1,613 were aged ≥ 65 years (39.9%). Higher event rates were observed for both co-primary outcomes in patients aged ≥ 65 years comparted with those aged < 65 years (11.2% vs. 7.9%, HR 1.49, 95% CI 1.22-1.83; 14.4% vs. 11.8%, HR 1.28, 95% CI 1.07-1.52, respectively). Complete revascularization reduced the first co-primary outcome in patients ≥ 65 years (9.7% vs 12.5%, HR 0.77; 95% CI 0.58-1.04) and < 65 years (6.7% vs 9.1%, HR 0.72; 95% CI 0.54-0.96)(interaction P=0.74). The second co-primary outcome was reduced in those ≥ 65 years (HR 0.56, 95% CI 0.43-0.74) and < 65 years (HR 0.48, 95% CI 0.37-0.61 (interaction P=0.37). A sensitivity analysis was performed with consistent results demonstrated using a 75-year threshold (albeit attenuated). ConclusionsIn patients with STEMI and multivessel CAD, complete revascularization compared with culprit-lesion-only PCI reduced major cardiovascular events regardless of patient age and could be considered as a revascularization strategy in older adults.

Effect of complete revascularization in acute coronary syndrome after 75 years old: insights from the BleeMACS registry

Effect of complete revascularization in acute coronary syndrome after 75 years old: insights from the BleeMACS registry

Effect of Complete Revascularization vs. Staged PCI of Secondary Lesion on LV Systolic Function in Patient with STEMI

After a myocardial infarction, early restoration of normal coronary perfusion reduces infract size, preserves left ventricular function, and lowers mortality. Reperfusion therapy's major goal is to not only restore the culprit epicardial vessel's patency, but also to reperfuse tissue to preserve myocyte viability and hence LV function. The pathophysiology of myocardial infarction, on the other hand, is not limited to the culprit vessel. The treatment of non-culprit lesions in STEMI is a contentious issue. Previously published guidelines (the 2011 PCI and 2013 STEMI guidelines) recommended treating the culprit lesion only if the patient was in cardiogenic shock. These guidelines are based on expert opinions rather than randomized controlled trials, which take into account safety concerns such as complications from repeated intervention, a low technical success rate, a high incidence of coronary restenosis, and renal insufficiency after contrast agent use. The aim of this work is to Long-term outcomes Lt ventricular ejection fraction (6 months) between complete revascularization and culprit-only revascularization (followed by staged percutaneous coronary intervention of secondary lesions) in STEMI patients with multi vessel coronary disease undergoing primary angioplasty. This prospective analysis included 50 patients with acute ST elevation myocardial infarction who were amenable to primary coronary intervention and were admitted to the critical care unit. And was blindly randomized alternatively into 2 groups: Group A: Complete coronary revascularisation during primary percutaneous intervention. Group B: Culprit-only revascularization during primary PCI. This study enrolled 50 patients, 35 males (70%) and 15 females (30%); in G I, there were 18 males (72%) and 7 females (18%) while in G II there were 17 males (68%) and 8 females (32%). The age ranged from 34 yrs. to 82 yrs. with mean age: In G I was 61.6 (±8.9) In G II was 62.2 (±12.9) were enrolled in this study, pre-procedural EF% (Mean±St) there was no significant difference between both groups. In G I, patients had a mean EF% 49.9±10.1 Versus 48.0±11.3 seen in G II. (P=0.54) In G I, there was no a significant difference between pre- procedural versus post-procedural mean EF%. (P=0.53) In G II, there was no a significant difference between pre-procedural versus post-procedural mean EF%. (P=0.14) We concluded that There were no significant differences between infarct-related artery revascularization and multivessel revascularization in the rates of 6-month MACE, Also, there were no differences as regard in-hospital mortality, stroke, cardiogenic shock and reinfarction, ejection fraction.

The effect of complete revascularization in patients with ST-segment elevation myocardial infarction with Killip class ≥ III

Background:The effect of complete revascularization (CR) on high-risk patients with ST-segment elevation myocardial infarction (STEMI) has remains a controversial issue, especially on patients in a critical condition. The aim of this study was to explore the effect of CR on patients with STEMI with Killip class ≥ III.Methods:From January 2008 to December 2014, 185 patients diagnosed with STEMI with Killip class ≥ III and multiple vessel coronary artery disease received primary percutaneous coronary intervention (PCI). Eighty-nine patients underwent culprit-only PCI, and the remaining 96 patients underwent immediate or staged PCI for CR. Out of the 96 patients in the CR group, 51 patients underwent immediate CR, and 45 patients underwent CR during the same hospitalization. Thirty-day and 1-year clinical outcomes were compared between the culprit-only PCI group and the CR group as well as between the immediate CR group and staged CR group.Results:There was a trend toward a lower incidence of post-PCI acute kidney injury in the culprit-only PCI group when compared with the CR group (14.8% vs. 26.0%; P = 0.069). Thirty-day and 1-year cardiovascular mortality and all-cause mortality were similar between the culprit-only PCI group and CR group. Decreased 1-year cardiovascular mortality and all-cause mortality were noted in the staged CR group compared with the immediate CR group.Conclusionwas associated a higher possibility of post-PCI acute kidney injury and did not seem to improve 30-day or 1-year clinical outcomes. Patients undergoing staged CR during the same hospitalization had better clinical outcomes.

Effects of complete revascularization on long-term treatment outcomes in patients with multivessel coronary artery disease over 80 years of age admitted for acute coronary syndrome.

The effects of complete revascularization (CR) on long-term treatment outcomes in patients over 80 years of age with acute coronary syndrome (ACS) and multivessel coronary artery disease (MVD) have not been sufficiently investigated. In this study, we analyzed data obtained in 305 patients over 80 years of age with MVD who were admitted in the period from January 2014 to August 2017 for ACS. The patients were divided into two groups. CR was performed in 131 patients, and 174 subjects had an intervention on the symptomatic artery only [incomplete revascularization (ICR)]. The primary endpoint was one-year occurrence of the major adverse cardiac events (MACE) including death, non-fatal myocardial infarction, stroke. We also recorded cases of repeat coronary artery intervention, major bleeding events, contrast-induced nephropathy and stent thrombosis that occurred within a period of 1 year. The MACE rate in patients undergoing CR was significantly lower during the 12-month observation period. No statistically significant differences were observed in the rates of repeat coronary artery intervention, bleeding events, contrast-induced nephropathy, and stent thrombosis. CR performed in patients over 80 years of age with ACS due to MVD decreases the incidence of MACE without increasing the risk of periprocedural complications.