March 26, 2010 – Nearly 14 percent of Medicare beneficiaries admitted with a primary diagnosis of ST-elevated myocardial infarction (STEMI) undergo multivessel 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 multivessel intervention experience higher unadjusted morbidity/mortality than those patients undergoing single vessel PCI. However, multivessel PCI was not a significant predictor of mortality once comorbid conditions were controlled in the regression model. These are among the findings of new research presented by Aaron D. Kugelmass, M.D., Baystate Medical Center, Springfield, Mass., at the American College of Cardiology's Scientific Sessions 2010 in Atlanta.
According to the study, STEMI patients undergoing multivessel 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 coronary artery bypass graft surgery (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 Oct. 1, 2006 and Sept. 30, 2007 and included 24,189 MB.
The study compared the following clinical outcomes between the MB undergoing single-vessel versus multivessel 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 multivessel 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, M.D., interventional cardiologist and director, cardiovascular research, Mid America Heart Institute, St. Luke's Hospital; Matthew R. Reynolds, M.D., electrophysiologist and director, Economics and Quality of Life Assessment Group, Harvard Clinical Research Institute; and Steven D. Culler, Ph.D., associate professor, Rollins School of Public Health, Emory University.
Cardiac Data Solutions provides consultation services, data analysis, clinical benchmarks, management tools, research support services and leadership training to hospitals, physicians, payors, manufacturers and the financial community.
For more information: http://tinyurl.com/ycue7xb, www.cardiacdatasolutions.com/cds/jsp/documents/Multi-Vessel%20Primary%20PCI%20Avisable%20%20Differences%20in%20Clinical%20Outcomes%20amongv4%20%20%20%20%20.pdf