Vol 69, No 4 (2011)
Original articles
Published online: 2011-04-26

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Impact of multivessel coronary disease on one-year clinical outcomes and five-year mortality in patients with ST-elevation myocardial infarction undergoing percutaneous coronary intervention

Andrzej Lekston, Mateusz Tajstra, Mariusz Gąsior, Marek Gierlotka, Damian Pres, Bartosz Hudzik, Przemysław Trzeciak, Zbigniew Kalarus, Lech Poloński, Marian Zembala
DOI: 10.33963/v.kp.79348
Kardiol Pol 2011;69(4):336-343.

Abstract


Background: Multivessel coronary disease (MVD) occurs in approximately 40–65% of patients with ST-segment elevation myocardial infarction (STEMI) treated with percutaneous coronary intervention (PCI), and is associated with significantly increased morbidity and mortality rates.
Aim: To evaluate the impact of MVD on in-hospital and long-term clinical outcomes in patients with STEMI and PCI, and to compare these results with those from a group of patients with a single coronary vessel disease (SVD).
Methods: Consecutive patients with STEMI treated with PCI were included in the analysis. Patients were divided into two groups: patients with SVD (n = 828, 46.6%) and patients with MVD (n = 948, 53.4%). Clinical follow-up was performed at 12 months, and five-year mortality was assessed. Major adverse cardiac events (MACE) at 12-month follow-up were defined as death (from any cause), stroke, need for percutaneous or any surgical coronary artery revascularisation, and non-fatal myocardial infarction.
Results: The in-hospital mortality was 2.9% vs 9.5% (p < 0.0001) and the five-year mortality was 11.9% vs 23.8% (p < 0.0001), for SVD vs MVD patients, respectively. The cumulative incidence of MACE during 12-month follow-up was significantly higher in patients with MVD (32.5% vs 14.5%, p < 0.0001). Moreover, multivariate analysis revealed that after a correction for baseline differences, the presence of MVD was a strong and independent predictor for five-year mortality in patients treated with PCI (hazard ratio 1.45, 95% confidence interval 1.13-1.88, p = 0.004).
Conclusions: The presence of MVD in patients with STEMI is a strong and independent risk factor for higher long-term mortality.
Kardiol Pol 2011; 69, 4: 336-343

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Polish Heart Journal (Kardiologia Polska)