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Culprit-vessel intervention reduced 1-year mortality in STEMI
Compared with multivessel intervention, culprit-vessel intervention independently predicted a 35% reduction in 1-year mortality in a cohort of patients with STEMI, according to results of a recent observational analysis.
Researchers of the study, which was published in Circulation: Cardiovascular Quality and Outcomes, aimed to compare culprit-vessel intervention with multivessel intervention in a cohort of 3,984 patients with multivessel disease undergoing primary PCI for STEMI.
Participants were accrued from eight tertiary cardiac centers in London between 2004 and 2011.
The researchers created a multivariate adjusted model to determine predictive factors for outcomes, including in-hospital MACE and all-cause mortality at 1 year. They also used propensity score methods to reduce the likelihood of bias.
In-hospital MACE rates were 4.6% for culprit-vessel intervention and 7.2% for multivessel intervention (P=.010). Mortality at 1 year was also lower in the culprit-vessel intervention group (7.4% vs. 10.1%; P=.031).
In the full cohort, culprit-vessel intervention independently predicted decreases in in-hospital MACE (OR=0.49; 95% CI, 0.32-0.75) and 1-year survival (OR=0.65; 95% CI, 0.47-0.91).
Findings from 2,821 patients in the propensity-matched cohort suggested similar trends, with in-hospital MACE (OR=0.49; 95% CI, 0.32-0.76) and 1-year survival (HR=0.64; 95% CI, 0.45-0.90) both being reduced by culprit-vessel intervention vs. multivessel intervention.
This trend was confirmed in an inverse probability treatment weighted analysis. Those results demonstrated that culprit vessel intervention independently predicted reductions in in-hospital MACE (OR=0.38; 95% CI, 0.15-0.96) and 1-year survival (HR=0.44; 95% CI, 0.21-0.93) compared with multivessel intervention.
“In this observational analysis of patients with [STEMI] undergoing primary [PCI], [culprit-vessel intervention] was associated with increased survival at 1 year,” the researchers concluded. “Acknowledging the limitations with observational analyses, our findings support current recommended practice guidelines.”
Disclosure: The researchers report no relevant financial disclosures.