More Research Needed to Determine Best Treatment of Multi-Vessel Coronary Artery Disease During Primary PCI for ST-Segment Elevation Myocardial Infarction

Multi-vessel primary PCI is performed frequently despite current recommendations to the contrary

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Mar 18, 2010, 08:20 ET

ATLANTA, March 18 /PRNewswire/ -- Nearly 14 percent of Medicare beneficiaries admitted with a primary diagnosis of ST-Segment Elevation Myocardial Infarction (STEMI) undergo multi-vessel primary percutaneous coronary intervention (PCI), despite recommendations from the American College of Cardiology and the American Heart Association to intervene on only the culprit vessel. Those patients undergoing multi-vessel intervention experience higher unadjusted morbidity/mortality than those patients undergoing single vessel PCI. However, multi-vessel PCI was not a significant predictor of mortality once co-morbid conditions were controlled in the regression model. These are among the findings of new research presented this week by Dr. Aaron D. Kugelmass of Baystate Medical Center at the American College of Cardiology's Scientific Sessions 2010 in Atlanta. Read the research at: http://tinyurl.com/ycue7xb.

According to the study, STEMI patients undergoing multi-vessel PCI were more likely to be male, experience cardiogenic shock and have a drug-eluting stent. They also experience increased unadjusted in-hospital mortality, are more likely to experience Acute Renal Failure, and have a lower incidence of CABG than those undergoing single vessel PCI.

The research, funded and conducted by Cardiac Data Solutions, studied data on Medicare beneficiaries (MB) with a primary diagnosis of STEMI (first diagnosis code) that underwent a PCI during hospitalization between October 1, 2006 and September 30, 2007 and included 24,189 MB.

The study compared the following clinical outcomes between the MB undergoing single-vessel versus multi-vessel PCI:

Acute renal failure
New-onset hemodialysis
Any vascular complication
Observed mortality
Expected mortality
Stent type and usage

"The study supports the current recommendations that STEMI patients undergo culprit vessel PCI only, however, prospective assessment of this question is needed to identify the best treatment strategy for patients with STEMI and multi-vessel CAD," said April Simon, RN, MSN, president of Cardiac Data Solutions and one of the researchers.

Other researchers included: Phillip P. Brown, cardiovascular surgeon (retired) and past chairman, Department of Surgery, Centennial Medical Center; David J. Cohen, MD, interventional cardiologist and director, Cardiovascular Research, Mid America Heart Institute, St. Luke's Hospital; Matthew R. Reynolds, MD, electrophysiologist and director, Economics and Quality of Life Assessment Group, Harvard Clinical Research Institute; and Steven D. Culler, PhD, associate professor, Rollins School of Public Health, Emory University.

About Cardiac Data Solutions, Inc. (CDS)

Founded in 1999, Cardiac Data Solutions, Inc. (CDS) provides consultation services, data analysis, clinical benchmarks, management tools, research support services and leadership training to hospitals, physicians, payors, manufacturers and the financial community. CDS is focused solely on the cardiovascular market with the primary mission of supporting and improving clinical and business decisions to improve the quality of patient care. Using proprietary data analysis tools with comprehensive and current data on clinical outcomes, CDS helps identify opportunities for improvement and develops evidence-based strategies to achieve them. For more information, visit http://www.cardiacdatasolutions.com.