Impact of Multivessel Revascularization on Health Status Outcomes in Patients with ST-Segment Elevation Myocardial Infarction and Multivessel Coronary Artery Disease

Jae Sik Jang, John A. Spertus, Suzanne V. Arnold, Ali Shafiq, Anna Grodzinsky, Timothy J. Fendler, Adam C. Salisbury, Fengming Tang, Edward J. McNulty, J. Aaron Grantham, David J. Cohen, Amit P. Amin

Research output: Contribution to journalArticlepeer-review

9 Scopus citations

Abstract

Background Up to 65% of patients with ST-segment elevation myocardial infarction (STEMI) have multivessel coronary artery disease (MVCAD). Long-term health status of STEMI patients after multivessel revascularization is unknown. Objectives This study investigated the relationship between multivessel revascularization and health status outcomes (symptoms and quality of life [QoL]) in STEMI patients with MVCAD. Methods Using a U.S. myocardial infarction registry and the Seattle Angina Questionnaire (SAQ), we determined the health status of patients with STEMI and MVCAD at the time of STEMI and 1 year later. We assessed the association of multivessel revascularization during index hospitalization with 1-year health status using multivariable linear regression analysis, and also examined demographic, clinical, and angiographic factors associated with multivessel revascularization. Results Among 664 STEMI patients with MVCAD, 251 (38%) underwent multivessel revascularization. Most revascularizations were staged during the index hospitalization (64.1%), and 8.0% were staged after discharge, with 27.9% performed during primary percutaneous coronary intervention. Multivessel revascularization was associated with age and more diseased vessels. At 1 year, multivessel revascularization was independently associated with improved symptoms (4.5 points higher SAQ angina frequency score; 95% confidence interval [CI]: 1.0 to 7.9) and QoL (6.6 points higher SAQ QoL score; 95% CI: 2.7 to 10.6). One-year mortality was not different between those who did and did not undergo multivessel revascularization (3.6% vs. 3.4%; log-rank test p = 0.88). Conclusions Multivessel revascularization improved angina and QoL in STEMI patients with MVCAD. Patient-centered outcomes should be considered in future trials of multivessel revascularization.

Original languageEnglish
Pages (from-to)2104-2113
Number of pages10
JournalJournal of the American College of Cardiology
Volume66
Issue number19
DOIs
StatePublished - 2015

Keywords

  • myocardial infarction
  • percutaneous coronary intervention
  • quality of health care

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