TY - JOUR
T1 - Prognostic impact of staged versus "one-time" multivessel percutaneous intervention in acute myocardial infarction
T2 - Analysis from the HORIZONS-AMI (Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction) trial
AU - Kornowski, Ran
AU - Mehran, Roxana
AU - Dangas, George
AU - Nikolsky, Eugenia
AU - Assali, Abid
AU - Claessen, Bimmer E.
AU - Gersh, Bernard J.
AU - Wong, S. Chiu
AU - Witzenbichler, Bernhard
AU - Guagliumi, Giulio
AU - Dudek, Dariusz
AU - Fahy, Martin
AU - Lansky, Alexandra J.
AU - Stone, Gregg W.
N1 - Funding Information:
The study was supported by the Cardiovascular Research Foundation and with grant support from Boston Scientific and Medicines Company . Dr. Mehran has received lecture fees from Boston Scientific and The Medicines Company; is a consultant to/on the advisory board of Abbott Vascular, AstraZeneca, Ortho McNeil, and Regado Biosciences; and has received a research grant from BMS/Sanofi-Aventis . Dr. Dangas reports receiving lecture fees from Abbott Vascular, AstraZeneca, Cordiva, Cordis, and The Medicines Company; consulting fees from Regado Biosciences; and research suppport from BMS/Sanofi-Aventis. Dr. Nikolsky is a consultant for Medtronic Cardiovasular. Dr. Gersh has received consulting fees from or serving on advisory boards for AstraZeneca, Bristol-Myers Squibb, Abbott Laboratories, Boston Scientific, Ortho-McNeil Janssen Scientific Affairs, Amorcyte, GE Healthcare, St. Jude Medical Inc., Medispec Limited, and Merck & Co.; and has equity interest in CV Therapeutics. Dr. Wong is a member of the Medical Advisory Board of Boston Scientific. Dr. Witzenbichler has received lecture fees from Boston Scientific and The Medicines Company. Dr. Guagliumi has received consulting fees from or has served on advisory boards for Abbott Vascular, Boston Scientific, Volcano, and Cordis; and receives grant support from Medtronic , Boston Scientific , Abbott , Lightlab , and Labcoat . Dr. Dudek reports receiving lecture fees from Nycomed; and research grants from or served as consultant/advisory board member for Abbott , Adamed , Biotronik , Balton , Bayer , BBRaun , BioMatrix , Boston Scientific , Boehringer Ingelheim , Bristol-Myers Squibb , Cordis , Cook , Eli Lilly , EuroCor , GlaxoSmithKline , Invatec , Medtronic , The Medicines Company , MSD , Nycomed , Orbus-Reich , Pfizer , Possis , Promed , Sanofi-Aventis , Siemens , Solvay , Terumo , and Tyco . Drs. Fahy and Lansky report being employed by the Cardiovascular Research Foundation. Dr. Stone reports receiving consulting fees from Medtronic, GlaxoSmithKline, Eli Lilly, and Bristol-Myers Squibb, and grant support from Boston Scientific , The Medicines Company , and Abbott Vascular . All other authors have reported that there are no relationships to disclose.
PY - 2011/8/9
Y1 - 2011/8/9
N2 - Objectives: The purpose of this study was to compare a one-time primary percutaneous coronary intervention (PCI) of the culprit and nonculprit lesions with PCI of only the culprit lesion and staged nonculprit PCI at a later date in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease. Background: In patients with STEMI and multivessel disease, it is unknown whether it is safe or even desirable to also treat the nonculprit vessel during the primary PCI procedure. Methods: In the HORIZONS-AMI (Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction) trial, 668 of the 3,602 STEMI patients enrolled (18.5%) underwent PCI of culprit and nonculprit lesions for multivessel disease. Patients were categorized into a single PCI strategy (n = 275) versus staged PCI (n = 393). The endpoints analyzed included the 1-year rates of major adverse cardiovascular events and its components, death, reinfarction, target-vessel revascularization for ischemia, and stroke. Results: Single versus staged PCI was associated with higher 1-year mortality (9.2% vs. 2.3%; hazard ratio [HR]: 4.1, 95% confidence interval [CI]: 1.93 to 8.86, p < 0.0001), cardiac mortality (6.2% vs. 2.0%; HR: 3.14, 95% CI: 1.35 to 7.27, p = 0.005), definite/probable stent thrombosis (5.7% vs. 2.3%; HR: 2.49, 95% CI: 1.09 to 5.70, p = 0.02), and a trend toward greater major adverse cardiovascular events (18.1% vs. 13.4%; HR: 1.42, 95% CI: 0.96 to 2.1, p = 0.08). The mortality advantage favoring staged PCI was maintained in a subgroup of patients undergoing truly elective multivessel PCI. Also, the staged PCI strategy was independently associated with lower all-cause mortality at 30 days and at 1 year. Conclusions: A deferred angioplasty strategy of nonculprit lesions should remain the standard approach in patients with STEMI undergoing primary PCI, as multivessel PCI may be associated with a greater hazard for mortality and stent thrombosis. (Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction [HORIZONS-AMI]; NCT00433966)
AB - Objectives: The purpose of this study was to compare a one-time primary percutaneous coronary intervention (PCI) of the culprit and nonculprit lesions with PCI of only the culprit lesion and staged nonculprit PCI at a later date in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease. Background: In patients with STEMI and multivessel disease, it is unknown whether it is safe or even desirable to also treat the nonculprit vessel during the primary PCI procedure. Methods: In the HORIZONS-AMI (Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction) trial, 668 of the 3,602 STEMI patients enrolled (18.5%) underwent PCI of culprit and nonculprit lesions for multivessel disease. Patients were categorized into a single PCI strategy (n = 275) versus staged PCI (n = 393). The endpoints analyzed included the 1-year rates of major adverse cardiovascular events and its components, death, reinfarction, target-vessel revascularization for ischemia, and stroke. Results: Single versus staged PCI was associated with higher 1-year mortality (9.2% vs. 2.3%; hazard ratio [HR]: 4.1, 95% confidence interval [CI]: 1.93 to 8.86, p < 0.0001), cardiac mortality (6.2% vs. 2.0%; HR: 3.14, 95% CI: 1.35 to 7.27, p = 0.005), definite/probable stent thrombosis (5.7% vs. 2.3%; HR: 2.49, 95% CI: 1.09 to 5.70, p = 0.02), and a trend toward greater major adverse cardiovascular events (18.1% vs. 13.4%; HR: 1.42, 95% CI: 0.96 to 2.1, p = 0.08). The mortality advantage favoring staged PCI was maintained in a subgroup of patients undergoing truly elective multivessel PCI. Also, the staged PCI strategy was independently associated with lower all-cause mortality at 30 days and at 1 year. Conclusions: A deferred angioplasty strategy of nonculprit lesions should remain the standard approach in patients with STEMI undergoing primary PCI, as multivessel PCI may be associated with a greater hazard for mortality and stent thrombosis. (Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction [HORIZONS-AMI]; NCT00433966)
KW - angioplasty
KW - coronary artery disease
KW - myocardial infarction
KW - stenting
UR - http://www.scopus.com/inward/record.url?scp=79961184794&partnerID=8YFLogxK
U2 - 10.1016/j.jacc.2011.02.071
DO - 10.1016/j.jacc.2011.02.071
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C2 - 21816305
AN - SCOPUS:79961184794
SN - 0735-1097
VL - 58
SP - 704
EP - 711
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 7
ER -
