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Open AccessArticle

Complete Revascularization of Multivessel Coronary Artery Disease Does Not Improve Clinical Outcome in ST-Segment Elevation Myocardial Infarction Patients with Reduced Left Ventricular Ejection Fraction

Department of Internal Medicine and Cardiovascular Centre, Seoul National University Hospital, Seoul 03080, Korea
*
Author to whom correspondence should be addressed.
These authors contributed equally to this work.
J. Clin. Med. 2020, 9(1), 232; https://doi.org/10.3390/jcm9010232 (registering DOI)
Received: 27 November 2019 / Revised: 7 January 2020 / Accepted: 8 January 2020 / Published: 15 January 2020
(This article belongs to the Special Issue Clinical Research of Percutaneous Coronary Intervention)
The benefit of complete revascularization (CR) in ST-segment elevation myocardial infarction (STEMI) patients with left ventricular (LV) dysfunction is uncertain. A total of 1314 STEMI patients with multivessel coronary artery disease were analyzed. CR was defined angiographically and by a residual Synergy between PCI with Taxus and Cardiac Surgery trial (SYNTAX) score (SS) <8. Patients with a left ventricular ejection fraction (LVEF) <40% were classified as the reduced LVEF group. The major study endpoints were patient-oriented composite outcome (POCO) and cardiac death during three-year follow-up. Overall, patients that received angiographic CR (579 patients, 44.1%) had significantly lower three-year clinical events compared with incomplete revascularization (iCR). CR reduced three-year POCO and cardiac death rates in the preserved LVEF group (POCO: 13.2% vs. 21.9%, p < 0.001, cardiac death: 1.8% vs. 6.5%, p < 0.001, respectively) but not in the reduced LVEF group (POCO: 26.0% vs. 33.1%, p = 0.275, cardiac death: 15.1% vs. 19.0%, p = 0.498, respectively). Multivariate analysis showed that CR significantly reduced three-year POCO (hazard ration (HR) 0.59, 95% confidence interval (CI) 0.43–0.82) and cardiac death (HR 0.34, 95% CI 0.14–0.80), only in the preserved LVEF group. Additionally, the results were corroborated using the SS-based CR definition. In STEMI patients with multivessel disease, CR did not improve clinical outcomes in those with reduced LVEF. View Full-Text
Keywords: percutaneous coronary intervention; ST-segment elevation myocardial infarction; complete revascularization; infarct-related artery only treatment; multivessel disease; left ventricular ejection fraction percutaneous coronary intervention; ST-segment elevation myocardial infarction; complete revascularization; infarct-related artery only treatment; multivessel disease; left ventricular ejection fraction
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Kang, J.; Zheng, C.; Park, K.W.; Park, J.; Rhee, T.; Lee, H.S.; Han, J.-K.; Yang, H.-M.; Kang, H.-J.; Koo, B.-K.; Kim, H.-S. Complete Revascularization of Multivessel Coronary Artery Disease Does Not Improve Clinical Outcome in ST-Segment Elevation Myocardial Infarction Patients with Reduced Left Ventricular Ejection Fraction. J. Clin. Med. 2020, 9, 232.

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