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

EuroIntervention. 2019 Dec 6;15(11):e1014-e1021. doi: 10.4244/EIJ-D-19-00034.

Abstract

Aims: 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.

Methods and results: 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]).

Conclusions: Multivessel PCI was associated with similar outcomes compared to IRA-only PCI in patients with AMI, MVD, and severe RD.

MeSH terms

  • Coronary Artery Disease* / complications
  • Coronary Artery Disease* / surgery
  • Humans
  • Kidney Diseases* / complications
  • Myocardial Infarction*
  • Patients
  • Percutaneous Coronary Intervention*
  • Treatment Outcome