Impact of Complete Revascularization on Six-Year Clinical Outcomes and Incidence of Acute Decompensated Heart Failure in Patients With ST-Segment Elevation Myocardial Infarction and Multivessel Coronary Artery Disease

摘要

It remains unclear whether complete revascularization (CR) reduces the incidences of acute decompensated heart failure (ADHF) and adverse cardiac outcomes in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel coronary artery disease (MVD). A total of 453 hemodynamically stable patients with STEMI and MVD were retrospectively evaluated; the patients were divided into 2 groups according to interventional strategy: CR (n?=?240) and incomplete revascularization (IR) (n?=?213). We analyzed the incidences of ADHF and major adverse cardiac events (MACE; a composite of all-cause mortality, myocardial infarction, and any revascularization) over a long follow-up period (median 6.3 years). MACE developed in 158 patients (34.9%), and 40 patients (8.8%) were re-admitted because of ADHF developing during follow-up. Results after propensity matching showed that CR did not reduce the incidence of ADHF (hazard ratio [HR] for IR 1.63, 95% confidence interval [CI] 0.63 to 4.22, p?=?0.311). However, IR increased the risk of MACE (HR 1.73, 95% CI 1.09 to 2.74, p?=?0.021), attributable principally to an increased risk of nontarget vessel revascularization (HR 3.12, 95% CI 1.23 to 7.92, p?=?0.039). Although CR did not reduce the incidence of ADHF, CR might reduce repeat revascularization to treat non–infarct-related arteries in hemodynamically stable patients with STEMI and MVD.