An Observational Study Assessing Immediate Complete Versus Delayed Complete Revascularisation in Patients with Multi-Vessel Disease Undergoing Primary Percutaneous Coronary Intervention
Background: More than half of the patients undergoing primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) have multi-vessel coronary artery disease. This is associated with worse outcomes compared with single vessel disease. Whilst evidence now exi...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
SAGE Publishing
2020-08-01
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| Series: | Clinical Medicine Insights: Cardiology |
| Online Access: | https://doi.org/10.1177/1179546820951792 |
| _version_ | 1811222240939737088 |
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| author | Krishnaraj Sinhji Rathod Marco Spagnolo Mark K Elliott Anne-Marie Beirne Elliot J Smith Rajiv Amersey Charles Knight Roshan Weerackody Andreas Baumbach Anthony Mathur Daniel A Jones |
| author_facet | Krishnaraj Sinhji Rathod Marco Spagnolo Mark K Elliott Anne-Marie Beirne Elliot J Smith Rajiv Amersey Charles Knight Roshan Weerackody Andreas Baumbach Anthony Mathur Daniel A Jones |
| author_sort | Krishnaraj Sinhji Rathod |
| collection | DOAJ |
| description | Background: More than half of the patients undergoing primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) have multi-vessel coronary artery disease. This is associated with worse outcomes compared with single vessel disease. Whilst evidence now exists to support complete revascularisation for bystander disease the optimal timing is still debated. This study aimed to compare clinical outcomes in patients with STEMI and multi-vessel disease who underwent complete revascularisation as inpatients in comparison to patients who had staged PCI as early outpatients. Methods and results: We conducted an observational cohort study consisting of 1522 patients who underwent primary PCI with multi-vessel disease from 2012 to 2019. Exclusions included patients with cardiogenic shock and previous CABG. Patients were split into 2 groups depending on whether they had complete revascularisation performed as inpatients or as staged PCI at later outpatient dates. The primary outcome of this study was major adverse cardiac events (consisting of myocardial infarction, target vessel revascularisation and all-cause mortality). 834 (54.8%) patients underwent complete inpatient revascularisation and 688 patients (45.2%) had outpatient PCI (median 43 days post discharge). Of the inpatient group, 652 patients (78.2%) underwent complete revascularisation during the index procedure whilst 182 (21.8%) patients underwent inpatient bystander PCI in a second procedure. Overall, there were no significant differences between the groups with regards to their baseline or procedural characteristics. Over the follow-up period there was no significant difference in MACE between the cohorts ( P = .62), which persisted after multivariate adjustment (HR 1.21 [95% CI 0.72-1.96]). Furthermore, in propensity-matched analysis there was no significant difference in outcome between the groups (HR: 0.86 95% CI: 0.75-1.25). Conclusions: Our study demonstrated that the timing of bystander PCI after STEMI did not appear to have an effect on cardiovascular outcomes. We suggest that patients with multi-vessel disease can potentially be discharged promptly and undergo early outpatient bystander PCI. This could significantly reduce length of stay in hospital. |
| first_indexed | 2024-04-12T08:12:23Z |
| format | Article |
| id | doaj.art-6ce2358235a54d70951423a0e91a941f |
| institution | Directory Open Access Journal |
| issn | 1179-5468 |
| language | English |
| last_indexed | 2024-04-12T08:12:23Z |
| publishDate | 2020-08-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Clinical Medicine Insights: Cardiology |
| spelling | doaj.art-6ce2358235a54d70951423a0e91a941f2022-12-22T03:40:55ZengSAGE PublishingClinical Medicine Insights: Cardiology1179-54682020-08-011410.1177/1179546820951792An Observational Study Assessing Immediate Complete Versus Delayed Complete Revascularisation in Patients with Multi-Vessel Disease Undergoing Primary Percutaneous Coronary InterventionKrishnaraj Sinhji Rathod0Marco Spagnolo1Mark K Elliott2Anne-Marie Beirne3Elliot J Smith4Rajiv Amersey5Charles Knight6Roshan Weerackody7Andreas Baumbach8Anthony Mathur9Daniel A Jones10Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, UKBarts Interventional Group, Interventional Cardiology, Barts Heart Centre, St Bartholomew’s Hospital, London, UKBarts Interventional Group, Interventional Cardiology, Barts Heart Centre, St Bartholomew’s Hospital, London, UKCentre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, UKBarts Interventional Group, Interventional Cardiology, Barts Heart Centre, St Bartholomew’s Hospital, London, UKBarts Interventional Group, Interventional Cardiology, Barts Heart Centre, St Bartholomew’s Hospital, London, UKCentre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, UKBarts Interventional Group, Interventional Cardiology, Barts Heart Centre, St Bartholomew’s Hospital, London, UKCentre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, UKCentre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, UKCentre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, UKBackground: More than half of the patients undergoing primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) have multi-vessel coronary artery disease. This is associated with worse outcomes compared with single vessel disease. Whilst evidence now exists to support complete revascularisation for bystander disease the optimal timing is still debated. This study aimed to compare clinical outcomes in patients with STEMI and multi-vessel disease who underwent complete revascularisation as inpatients in comparison to patients who had staged PCI as early outpatients. Methods and results: We conducted an observational cohort study consisting of 1522 patients who underwent primary PCI with multi-vessel disease from 2012 to 2019. Exclusions included patients with cardiogenic shock and previous CABG. Patients were split into 2 groups depending on whether they had complete revascularisation performed as inpatients or as staged PCI at later outpatient dates. The primary outcome of this study was major adverse cardiac events (consisting of myocardial infarction, target vessel revascularisation and all-cause mortality). 834 (54.8%) patients underwent complete inpatient revascularisation and 688 patients (45.2%) had outpatient PCI (median 43 days post discharge). Of the inpatient group, 652 patients (78.2%) underwent complete revascularisation during the index procedure whilst 182 (21.8%) patients underwent inpatient bystander PCI in a second procedure. Overall, there were no significant differences between the groups with regards to their baseline or procedural characteristics. Over the follow-up period there was no significant difference in MACE between the cohorts ( P = .62), which persisted after multivariate adjustment (HR 1.21 [95% CI 0.72-1.96]). Furthermore, in propensity-matched analysis there was no significant difference in outcome between the groups (HR: 0.86 95% CI: 0.75-1.25). Conclusions: Our study demonstrated that the timing of bystander PCI after STEMI did not appear to have an effect on cardiovascular outcomes. We suggest that patients with multi-vessel disease can potentially be discharged promptly and undergo early outpatient bystander PCI. This could significantly reduce length of stay in hospital.https://doi.org/10.1177/1179546820951792 |
| spellingShingle | Krishnaraj Sinhji Rathod Marco Spagnolo Mark K Elliott Anne-Marie Beirne Elliot J Smith Rajiv Amersey Charles Knight Roshan Weerackody Andreas Baumbach Anthony Mathur Daniel A Jones An Observational Study Assessing Immediate Complete Versus Delayed Complete Revascularisation in Patients with Multi-Vessel Disease Undergoing Primary Percutaneous Coronary Intervention Clinical Medicine Insights: Cardiology |
| title | An Observational Study Assessing Immediate Complete Versus Delayed Complete Revascularisation in Patients with Multi-Vessel Disease Undergoing Primary Percutaneous Coronary Intervention |
| title_full | An Observational Study Assessing Immediate Complete Versus Delayed Complete Revascularisation in Patients with Multi-Vessel Disease Undergoing Primary Percutaneous Coronary Intervention |
| title_fullStr | An Observational Study Assessing Immediate Complete Versus Delayed Complete Revascularisation in Patients with Multi-Vessel Disease Undergoing Primary Percutaneous Coronary Intervention |
| title_full_unstemmed | An Observational Study Assessing Immediate Complete Versus Delayed Complete Revascularisation in Patients with Multi-Vessel Disease Undergoing Primary Percutaneous Coronary Intervention |
| title_short | An Observational Study Assessing Immediate Complete Versus Delayed Complete Revascularisation in Patients with Multi-Vessel Disease Undergoing Primary Percutaneous Coronary Intervention |
| title_sort | observational study assessing immediate complete versus delayed complete revascularisation in patients with multi vessel disease undergoing primary percutaneous coronary intervention |
| url | https://doi.org/10.1177/1179546820951792 |
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