Non-culprit coronary artery percutaneous coronary intervention during acute ST-segment elevation myocardial infarction: insights from the APEX-AMI trial

• Published in: European heart journal Vol. 31; no. 14; pp. 1701 - 1707
• Main Authors: Toma, Mustafa, Buller, Christopher E., Westerhout, Cynthia M., Fu, Yuling, O'Neill, William W., Holmes, David R., Hamm, Christian W., Granger, Christopher B., Armstrong, Paul W.
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01.07.2010
• Subjects: Adult; Aged; Angioplasty, Balloon, Coronary; Biological and medical sciences; Cardiology. Vascular system; Coronary Artery Disease - mortality; Coronary Artery Disease - therapy; Coronary heart disease; Diseases of the cardiovascular system; Female; Heart; Heart Failure - mortality; Humans; Kaplan-Meier Estimate; Male; Medical sciences; Middle Aged; Multicenter Studies as Topic; Myocardial infarction; Myocardial Infarction - mortality; Myocardial Infarction - therapy; Myocarditis. Cardiomyopathies; Non-culprit coronary artery; Primary percutaneous coronary intervention; Prognosis; Propensity Score; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Randomized Controlled Trials as Topic; Shock, Cardiogenic - mortality; Young Adult; Myocardial infarction; Atherectomy; Non-culprit coronary artery; Angioplasty; Acute; Coronary artery; Instrumentation therapy; Primary percutaneous coronary intervention; Cardiovascular disease; Coronary heart disease; Myocardial disease; Stent; Percutaneous route; ST elevation; Primary; Circulatory system; Cardiology; Apex
• ISSN: 0195-668X; 1522-9645; 1522-9645
• DOI: 10.1093/eurheartj/ehq129

Aims To examine the incidence of and propensity for non-culprit interventions performed at the time of the primary percutaneous coronary intervention (PCI) and its association with 90-day outcomes. Methods and results We examined the incidence, propensity for, and associated 90-day outcomes following non-culprit interventions performed at the time of primary PCI among ST-elevation myocardial infarction patients with multi-vessel coronary artery disease (MVD). Of the 5373 patients who underwent primary PCI in the APEX-AMI trial, 2201 had MVD. Of those, 217 (9.9%) underwent non-infarct-related arteries (IRA) PCI, whereas 1984 (90.1%) underwent PCI of the IRA alone. Ninety-day death and death/CHF/shock were higher in the non-IRA group compared with the IRA-only PCI group (12.5 vs. 5.6%, P (log-rank) < 0.001 and 17.4 vs. 12.0%, P (log-rank) = 0.020, respectively). After adjusting for patient and procedural characteristics as well as propensity for performing non-IRA PCI, this procedure remained independently associated with an increased hazard of 90-day mortality [adjusted hazard ratio 2.44, 95% CI (1.55–3.83), P < 0.001]. Conclusion Non-culprit coronary interventions were performed at the time of primary PCI in 10% of MVD patients and were significantly associated with increased mortality. Our data support current guideline recommendations discouraging the performance of such procedures in stable primary PCI patients. Prospective randomized study of this issue may be warranted.