Prevalence and real-world management of NSTEMI with multivessel disease

被引:20
作者
Baumann, Angus A. W. [1 ,2 ]
Tavella, Rosanna [1 ,3 ,4 ]
Air, Tracy M. [3 ,4 ]
Mishra, Aashka [1 ]
Montarello, Nicholas J. [1 ]
Arstall, Margaret [3 ,5 ]
Zeitz, Chris [1 ,3 ]
Worthley, Matthew, I [1 ,3 ]
Beltrame, John F. [1 ,3 ,4 ]
Psaltis, Peter J. [1 ,3 ,6 ]
机构
[1] Cent Adelaide Local Hlth Network CALHN, Dept Cardiol, Adelaide, SA, Australia
[2] Alice Springs Hosp, Dept Med, Alice Springs, NT, Australia
[3] Univ Adelaide, Adelaide Med Sch, Adelaide, SA, Australia
[4] Queen Elizabeth Hosp, Basil Hetzel Inst Translat Hlth Res, Woodville South, Australia
[5] Northern Adelaide Local Hlth Network NALHN, Adelaide, SA, Australia
[6] South Australian Hlth & Med Res Inst, Vasc Res Ctr, Lifelong Hlth Theme, North Terrace, Adelaide, SA, Australia
基金
英国医学研究理事会;
关键词
Non-ST elevation myocardial infarction (NSTEMI); multivessel coronary artery disease; coronary; PERCUTANEOUS CORONARY INTERVENTION; ELEVATION MYOCARDIAL-INFARCTION; ARTERY-DISEASE; OUTCOMES; PROGNOSIS; MORTALITY;
D O I
10.21037/cdt-21-518
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: Non-ST elevation myocardial infarction (NSTEMI) has higher post-discharge mortality than ST-elevation myocardial infarction (STEMI). Prognosis worsens in those with multivessel coronary disease (MVD). However, information about the prevalence and extent of MVD in NSTEMI is limited, in turn limiting insights into optimal treatment strategies. This study aimed to define the prevalence and extent of MVD, preferred treatment strategies and the predictors of MVD in a real-world NSTEMI population. Methods: The Coronary Angiogram Database of South Australia (CADOSA) was used to identify consecutive patients presenting to major teaching hospitals with NSTEMI between 2012 and 2016. Obtaining clinical and angiographic details, patients were stratified by the number of significantly diseased vessels (0,1,2,3-VD), defined by a stenosis of >_70%, or >_50% in the left main coronary artery. Data was analysed retrospectively. Results: The prevalence of MVD (2-or 3-VD) was 42% amongst 3,722 NSTEMI presentations. Multivariate logistic regression modelling showed age, male gender, diabetes, dyslipidaemia and prior myocardial infarction predicted MVD over 1-VD or 0-VD. Percutaneous coronary intervention (PCI) was performed in 42% of patients with MVD. This comprised 61% of 2-VD patients and only 22% of 3-VD patients, with 24% and 66% of each group referred for coronary bypass grafting, respectively. Among MVD patients treated with PCI, 76% had their culprit lesion treated alone in the index admission. Conclusions: In this NSTEMI cohort, over 40% had MVD. Notably, a minority of patients with MVD undergoing PCI received multivessel revascularisation. This real-world practice emphasises that further evaluation is required to determine whether complete revascularisation is beneficial in NSTEMI, as reported for STEMI.
引用
收藏
页码:1 / 11
页数:11
相关论文
共 30 条
[1]   ESC working group position paper on myocardial infarction with non-obstructive coronary arteries [J].
Agewall, Stefan ;
Beltrame, John F. ;
Reynolds, Harmony R. ;
Niessner, Alexander ;
Rosano, Giuseppe ;
Caforio, Alida L. P. ;
De Caterina, Raffaele ;
Zimarino, Marco ;
Roffi, Marco ;
Kjeldsen, Keld ;
Atar, Dan ;
Kaski, Juan C. ;
Sechtem, Udo ;
Tornvall, Per .
EUROPEAN HEART JOURNAL, 2017, 38 (03) :143-153
[2]  
AIHW, 2021, Heart, stroke and vascular disease-Australian facts
[3]  
Amsterdam EA, 2014, CIRCULATION, V130, P2354, DOI 10.1161/CIR.0000000000000133
[4]  
[Anonymous], 2021, Eur Heart J, V42, P1908, DOI 10.1093/eurheartj/ehaa895
[5]   Management of multivessel coronary artery disease in patients with non-ST-elevation myocardial infarction: a complex path to precision medicine [J].
Baumann, Angus A. W. ;
Mishra, Aashka ;
Worthley, Matthew I. ;
Nelson, Adam J. ;
Psaltis, Peter J. .
THERAPEUTIC ADVANCES IN CHRONIC DISEASE, 2020, 11
[6]   American College of Cardiology key data elements and definitions for measuring the clinical management and outcomes of patients with acute coronary syndromes - A report of the American College of Cardiology Task Force on Clinical Data Standards (Acute Coronary Syndromes Writing Committee) [J].
Cannon, CP ;
Battler, A ;
Brindis, RG ;
Cox, JL ;
Ellis, SG ;
Every, NR ;
Flaherty, JT ;
Harrington, RA ;
Krumholz, HM ;
Simoons, ML ;
Van de Werf, FJJ ;
Weintraub, WS ;
Mitchell, KR ;
Morrisson, SL ;
Brandis, RG ;
Anderson, HV ;
Cannom, DS ;
Chitwood, WR ;
Cigarroa, JE ;
Collins-Nakai, RL ;
Ellis, SG ;
Gibbons, RJ ;
Grover, FL ;
Heidenreich, PA ;
Khandheria, BK ;
Knoebel, SB ;
Krumholz, HL ;
Malenka, DJ ;
Mark, DB ;
McKay, CR ;
Passamani, ER ;
Radford, MJ ;
Riner, RN ;
Schwartz, JB ;
Shaw, RE ;
Shemin, RJ ;
Van Fossen, DB ;
Verrier, ED ;
Watkins, MW ;
Phoubandith, DR ;
Furnelli, T .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2001, 38 (07) :2114-2130
[7]   Left main and/or three-vessel disease in patients with non-ST-segment elevation myocardial infarction and low-risk GRACE score: Prevalence, clinical outcomes and predictors [J].
Carvalho, Joao Filipe ;
Belo, Adriana ;
Congo, Kisa ;
Neves, David ;
Santos, Ana Rita ;
Picarra, Bruno ;
Damasio, Ana Filipa ;
Aguiar, Jose .
REVISTA PORTUGUESA DE CARDIOLOGIA, 2018, 37 (11) :911-919
[8]   Multivessel percutaneous coronary intervention in patients with multivessel disease and acute myocardial infarction [J].
Corpus, RA ;
House, JA ;
Marso, SP ;
Grantham, A ;
Huber, KC ;
Laster, SB ;
Johnson, WL ;
Daniels, WC ;
Barth, CW ;
Giorgi, LV ;
Rutherford, BD .
AMERICAN HEART JOURNAL, 2004, 148 (03) :493-500
[9]  
Darling Chad E, 2013, Clin Epidemiol, V5, P229, DOI 10.2147/CLEP.S45646
[10]   Characterization and outcomes of women and men with non-ST-segment elevation myocardial infarction and nonobstructive coronary artery disease: Results from the Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes with Early Implementation of the ACC/AHA Guidelines (CRUSADE) Quality Improvement Initiative [J].
Gehrie, Erika R. ;
Reynolds, Harmony R. ;
Chen, Anita Y. ;
Neelon, Brian H. ;
Roe, Matthew T. ;
Gibler, W. Brian ;
Ohman, E. Magnus ;
Newby, L. Kristin ;
Peterson, Eric D. ;
Hochman, Judith S. .
AMERICAN HEART JOURNAL, 2009, 158 (04) :688-694