Impact of Multivessel Revascularization on Health Status Outcomes in Patients With ST-Segment Elevation Myocardial Infarction and Multivessel Coronary Artery Disease

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY

卷:66

Article

Jang, Jae-Sik^1,2,3  Spertus, John A.^1,2  Arnold, Suzanne V.^1,2  Shafiq, Ali^1,2  Grodzinsky, Anna^1,2  Fendler, Timothy J.^1,2  Salisbury, Adam C.^1,2  Tang, Fengming¹  McNulty, Edward J.⁴  Grantham, J. Aaron^1,2  Cohen, David J.^1,2  Amin, Amit P.^5,6 

[1] St Lukes Mid Amer Heart Inst, Cardiovasc Outcomes Res, Kansas City, MO 64111 USA

[2] Univ Missouri, Kansas City, MO 64110 USA

[3] Inje Univ, Coll Med, Busan Paik Hosp, Dept Cardiol, Busan, South Korea

[4] Kaiser Permanente Med Ctr, Div Cardiol, San Francisco, CA USA

[5] Washington Univ, Sch Med, Div Cardiovasc, St Louis, MO 63110 USA

[6] Barnes Jewish Hosp, St Louis, MO 63110 USA

关键词: myocardial infarction;    percutaneous coronary intervention;    quality of health care;   

DOI  :  10.1016/j.jacc.2015.08.873

来源: Elsevier

【 摘 要 】

BACKGROUND Up to 65% of patients with ST-segment elevation myocardial infarction (STEMI) have multivessel coronary artery disease (MVCAD). Long-term health status of STEMI patients after multivessel revascularization is unknown. OBJECTIVES This study investigated the relationship between multivessel revascularization and health status outcomes (symptoms and quality of life [QoL]) in STEMI patients with MVCAD. METHODS Using a U.S. myocardial infarction registry and the Seattle Angina Questionnaire (SAQ), we determined the health status of patients with STEMI and MVCAD at the time of STEMI and 1 year later. We assessed the association of multivessel revascularization during index hospitalization with 1-year health status using multivariable linear regression analysis, and also examined demographic, clinical, and angiographic factors associated with multivessel revascularization. RESULTS Among 664 STEMI patients with MVCAD, 251 (38%) underwent multivessel revascularization. Most revascularizations were staged during the index hospitalization (64.1%), and 8.0% were staged after discharge, with 27.9% performed during primary percutaneous coronary intervention. Multivessel revascularization was associated with age and more diseased vessels. At 1 year, multivessel revascularization was independently associated with improved symptoms (4.5 points higher SAQ angina frequency score; 95% confidence interval [CI]: 1.0 to 7.9) and QoL (6.6 points higher SAQ QoL score; 95% CI: 2.7 to 10.6). One-year mortality was not different between those who did and did not undergo multivessel revascularization (3.6% vs. 3.4%; log-rank test p = 0.88). CONCLUSIONS Multivessel revascularization improved angina and QoL in STEMI patients with MVCAD. Patient-centered outcomes should be considered in future trials of multivessel revascularization. (C) 2015 by the American College of Cardiology Foundation.

【 授权许可】

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