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Taner Seker

Osmaniye State Hospital, Turkey

Title: Late PCI and CABG for secondary intervention are associated with decreased MACE in patients with multivessel disease after successful primary PCI

Biography

Biography: Taner Seker

Abstract

Background: Most patients with ST elevation myocardial infarction (STEMI) have critical multivessel disease that requiring a second intervention. The optimal timing of secondary intervention is not clear. In this study, we aimed to investigate MACE rate regarding the type of secondary procedure to non-infarct related critical lesions in patients with STEMI and critical multi vessel disease.

Methods: A total of 212 consecutive patients with STEMI and critical multi vessel disease had been included in our study. Patients were divided into two groups according to occurrence of MACE. Primary PCI data were collected. Pre and post intervention coronary blood flow and complications were recorded. MACE data of patients were evaluated before discharge, after 3 and 9 months.

Results: A second coronary angiography was performed 132 (62.3%) of STEMI patients in 90 day after primer PCI. The non- infarct related lesions in 26 of 132 patients who underwent second coronary angiography were evaluated non-critically and decided to follow with medical treatment. Secondary PCI was performed 89 of 132 and 17 of 132 patients underwent CABG operation. Patients were divided into two groups according to MACE occurrence. Mean time interval to PCI was significantly lower in patients with MACE (p=0.028). EF (p=0.59) and rate of patients who underwent CABG (p=0.108) were lower, syntax score (p=0.55) and CAD history (p=0.056) were higher in patients with MACE; but there was no statistical significance. The cut-off value of time interval to PCI obtained by ROC curve analysis was 16,5 days for prediction of MACE in 9 months (sensitivity: 75.0%, specificity: 69.2%). The area under the curve (AUC) was 0.680 (p=0.039) (Figure-1).

Conclusion: Late PCI or CABG can be thought to be the optimal strategy for patients with STEMI and multivessel disease.