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No apparent benefit of Multivessel PCI among older STEMI patients: Study
Multivessel percutaneous coronary intervention (MV PCI) is not much beneficial for all older patients with ST-segment–elevation myocardial infarction (STEMI), suggests a study published in the Circulation: Cardiovascular Interventions.
Prior studies on the use of multivessel percutaneous coronary intervention (MV PCI) for patients with ST-segment–elevation myocardial infarction (STEMI) and multivessel coronary artery disease has yielded heterogeneous results. The recent COMPLETE trial (Complete Versus Culprit-Only Revascularization Strategies to Treat Multivessel Disease After Early PCI for STEMI) demonstrated that MV PCI was superior to culprit-only PCI among patients with STEMI. It is unclear how these trial results apply to clinical decisions encountered in routine practice.
A group of researchers from U.S.A studied STEMI admissions among patients >65 years with multivessel disease and Centers for Medicare and Medicaid Services–linked data in the National Cardiovascular Data Registry CathPCI Registry from July 1, 2009 to December 31, 2017. MV PCI was defined as PCI to a nonculprit lesion ≤45 days of the index procedure.
The primary outcome was the composite of death, myocardial infarction, and revascularization from 45 days through 1 year. To account for unmeasured confounders, an instrumental variable analysis was used to compare treatment strategies. The instrument was institutional rates of MV PCI. A falsification end point of postdischarge major bleeding was utilized to assess for residual confounding.
The results of the study are as follows:
- Of 56 332 admissions from 1102 institutions, 37.7% received MV PCI ≤45 days of index STEMI PCI.
- Of those undergoing MV PCI, 74.8% received complete revascularization.
- In unadjusted analysis, MV PCI was associated with a lower cumulative incidence of the composite outcome between 45 days and 1 year.
- In the instrumental variable analysis, there was no association between MV PCI and the composite outcome.
- An association between MV PCI and the falsification endpoint of major bleeding was not observed.
Thus, the researchers concluded that In this large, nationwide analysis, there was no benefit of MV PCI by 1 year among older STEMI patients. The clinical benefit of MV PCI may not extend equally outside of trials to include all patients, including those with more extreme ages and more complex decision-making.
Reference:
Comparative Outcomes of Percutaneous Coronary Intervention for ST-Segment-Elevation Myocardial Infarction Among Medicare Beneficiaries With Multivessel Coronary Artery Disease: An National Cardiovascular Data Registry Research to Practice Project by Secemsky E et. al published in the Circulation: Cardiovascular Interventions.
Doi:10.1161/circinterventions.120.010323
Dr. Shravani Dali has completed her BDS from Pravara institute of medical sciences, loni. Following which she extensively worked in the healthcare sector for 2+ years. She has been actively involved in writing blogs in field of health and wellness. Currently she is pursuing her Masters of public health-health administration from Tata institute of social sciences. She can be contacted at editorial@medicaldialogues.in.
Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: drkohli@medicaldialogues.in. Contact no. 011-43720751