Abstract:
BACKGROUND:Older adults presenting with acute myocardial infarction (MI) often have multivessel coronary artery disease amenable to percutaneous coronary intervention (PCI), yet the risks of multivessel intervention may outweigh potential benefits in these patients. We sought to determine if nonculprit intervention during the index PCI is associated with better outcomes among older patients with acute MI and multivessel disease. METHODS:We examined 19,271 ST-segment elevation MI (STEMI) and 31,361 non-STEMI (NSTEMI) patients 65years or older with multivessel disease in a linked CathPCI Registry-Medicare database, excluding patients with prior coronary artery bypass grafting, left main disease, or cardiogenic shock. Using inverse probability-weighted propensity adjustment, we compared mortality between patients receiving culprit-only vs multivessel intervention during the index PCI procedure. RESULTS:Most older MI patients (91% STEMI and 74% NSTEMI) received culprit-only intervention during the index PCI. Among STEMI patients, multivessel intervention during the index PCI was associated with higher 30-day mortality (8.3% vs 6.3%, adjusted hazard ratio [HR] 1.36, 95% CI 1.14-1.62) than culprit-only intervention, and this trend persisted at 1year (13.8% vs 12.2%, adjusted HR 1.14, 95% CI 0.99-1.31). No significant mortality differences were observed among NSTEMI patients at 30days (3.4% vs 4.1%, adjusted HR 1.01, 95% CI 0.88-1.15) or at 1year (10.1% vs 10.8%, adjusted HR 0.99, 95% CI 0.91-1.08). CONCLUSIONS:Nonculprit intervention during the index PCI was associated with worse outcomes among STEMI patients, but not NSTEMI patients.
journal_name
Am Heart Jjournal_title
American heart journalauthors
Wang TY,McCoy LA,Bhatt DL,Rao SV,Roe MT,Resnic FS,Cavender MA,Messenger JC,Peterson EDdoi
10.1016/j.ahj.2015.10.017subject
Has Abstractpub_date
2016-02-01 00:00:00pages
9-18eissn
0002-8703issn
1097-6744pii
S0002-8703(15)00636-5journal_volume
172pub_type
杂志文章,多中心研究,随机对照试验abstract::To explore the contribution of reperfusion injury to final infarct size after a short duration of ischemia, closed-chest dogs underwent 40 minutes of proximal left anterior descending artery occlusion followed by 3 days of reperfusion. Animals randomly received intracoronary adenosine (n = 8) at 3.75 mg/min during the...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(91)90272-j
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abstract:BACKGROUND:Complications of vascular access are one of the most common adverse events after coronary angiography and percutaneous coronary intervention (PCI) and are reported to occur in 1% to 9% of cases. There are conflicting reports of the association of vascular complications with the use of vascular closure device...
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journal_title:American heart journal
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pub_type: 临床试验,杂志文章,随机对照试验
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journal_title:American heart journal
pub_type: 杂志文章,随机对照试验
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pub_type: 临床试验,杂志文章,多中心研究
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pub_type: 临床试验,杂志文章,随机对照试验
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更新日期:1992-09-01 00:00:00
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更新日期:1989-12-01 00:00:00
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pub_type: 杂志文章,多中心研究
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pub_type: 临床试验,杂志文章,随机对照试验
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更新日期:2011-10-01 00:00:00
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更新日期:1988-12-01 00:00:00
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pub_type: 杂志文章
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更新日期:2005-12-01 00:00:00
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pub_type: 杂志文章
doi:
更新日期:1985-03-01 00:00:00
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更新日期:2006-03-01 00:00:00
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pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/0002-8703(82)90562-2
更新日期:1982-06-01 00:00:00
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pub_type: 杂志文章
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更新日期:2006-10-01 00:00:00