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Multivessel revascularization improves outcomes, quality of life in patients with STEMI
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Patients with STEMI and multivessel CAD who underwent multivessel revascularization experienced improvements to symptoms and quality of life compared with patients who received culprit-only revascularization, according to recent results.
Researchers ascertained the health status of 664 patients with STEMI and multivessel CAD at and 1 year after index hospitalization, according to responses to the 19-item Seattle Angina Questionnaire (SAQ). All participants were enrolled in the prospective, multicenter TRIUMPH study between April 2005 and December 2008.
The cohort included 251 patients who underwent multivessel revascularization. Of these procedures, 64.1% occurred during index hospitalization, 8% after discharge and 27.9% during PCI. The rate at which multivessel revascularization was performed varied substantially across participating sites, with a range of 0% to more than 70%, Jae-Sik Jang, MD, PhD, from Saint Luke’s Mid America Heart Institute in Kansas City, Missouri, and Inje University Busan Paik Hospital in Korea, and researchers wrote.
Factors associated with undergoing multivessel revascularization included a greater number of diseased vessels (RR = 1.31; 95% CI, 1.17-1.46 per additional vessel) and age, with a significantly lower likelihood of multivessel revascularization among older patients and a nonsignificant trend toward reduced likelihood among younger patients compared with those aged approximately 50 years.
The researchers observed a significant association between multivessel revascularization and improved incomes at 1 year, with a 4.5-point increase to SAQ angina frequency score and a 6.6-point improvement to SAQ quality-of-life score compared with culprit-only revascularization. There was no difference in mortality rate at 1 year among those who received multivessel revascularization (3.6%) and those who did not (3.4%; P = .88).
Results from sensitivity analyses assessing only patients who underwent PCI indicated similar results, with significant improvements to angina frequency score (5.34-point increase) and quality-of-life score (7.78-point increase) with multivessel compared with culprit-only PCI.
Timothy D. Henry
In a related editorial, Timothy D. Henry, MD, of Cedars-Sinai Heart Institute, Los Angeles, and Anthony Gershlick, MBBS, of the University of Leicester and National Institute of Health Research Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, Leicester, United Kingdom, wrote that the observed variation according to practice was of particular interest.
“This remarkable variation likely reflects our as-yet lack of robust evidence for this common but challenging patient population,” they wrote.
“What this group has done well is to highlight (again) that there is more to clinical research studies than hard endpoints, with [quality of life] often felt to be ‘soft and unimportant’ — something our patients (and families) would contest vigorously,” Henry and Gershlick added. “Quality assessment of clearly defined markers of [quality of life] in robust trials is imperative for the development of a holistic management strategy. These results remind us this should be an important goal for all clinical trials.” – by Adam Taliercio
Disclosure: Jang reports receiving support from a National Research Foundation of Korea grant. See the full study for a list of all other authors’ relevant financial disclosures. Henry and Gershlick report no relevant financial disclosures.
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