Multivessel Disease As A Prognostic Factor For Mortality In STEMI Patients

Kiril K. Karamfiloff 1 , Zhivka D. Stoykova 1 , Petya G. Georeva 2 , Diana K. Trendafilova 1 , and Julia B. Jorgova 1
  • 1 University Hospital “St. Ekaterina”, Sofia, Bulgaria
  • 2 Trudova medicina OOD, Sofia, Bulgaria


The main objective of this analysis was to define the influence of multivessel disease involvement compared to single vessel disease on mortality rates in STEMI patients. The retrospective study included 549 patients, hospitalized with STEMI in St. Ekaterina University Hospital (age - 62.66±12.56; women - 31.3%) from 01.06.2008 to 30.06.2011. One-vessel disease was found in 232 patients (44%) as compared to two-vessel disease in 165 patients - 31% and multivessel disease in 130 patients - 25%. There was LM stenosis (>30) in 11 patients (2%); ostial lesion in 33 patients (6.3%); presence of Ca in 37 patients (7%). A stent was implanted in 484 patients (91.8%), and GP IIb/IIIa was used in 400 patients (75.9%). There was significant increase in mortality rates in patients with multivessel disease: 15.6% - 46 patients, compared to one-vessel disease - 6.5% (15 patients) (p<=0.01). Both early (30 days) and late mortality (one year) rates were higher in the multivessel group (6.8% vs. 2.6%, p<=0.05 and 10.2% vs. 3.9% (p<=0.0510), respectively. Multivessel disease is associated with higher mortality rates in STEMI patients, which may further alter clinical course and decision making.

If the inline PDF is not rendering correctly, you can download the PDF file here.

  • 1. Karha J, Murphy SA, Kirtane AJ, de Lemos JA, Aroesty JM, Cannon CP, et al. Evaluation of the association of proximal coronary culprit artery lesion location with clinical outcomes in acute myocardial infarction. Am J Cardiol. 2003;92(8):913-8.

  • 2. Elsman P, van't Hof AW, Hoorntje JC, de Boer MJ, Borm GF, Suryapranata H, et al. Effect of coronary occlusion site on angiographic and clinical outcome in acute myocardial infarction patients treated with early coronary intervention. Am J Cardiol. 2006;97(8):1137-41.

  • 3. Lekston, Andrzej, Szkodziński J, Gąsior M, Tajstra M, Kalarus Z, et al. Spontaneous reperfusion before intervention improves immediate but not long-term prognosis in diabetic patients with ST-segment elevation myocardial infarction and multivessel coronary artery disease. Cardiol J. 2013;20(4):378-84.

  • 4. O'Keefe JH Jr, Rutherford BD, McConahay DR, Ligon RW, Johnson WL Jr, Giorgi LV, et al. Early and late results of coronary angioplasty without antecedent thrombolytic therapy for acute myocardial infarction. Am J Cardiol. 1989;64(19):1221-30.

  • 5. Waldecker B, Waas W, Haberbosch W, Voss R, Heizmann H, Tillmanns H, et al. Long term follow-up after direct percutaneous transluminal coronary angioplasty for acute myocardial infarction. J Am Coll Cardiol. 1998;32(5):1320-5.

  • 6. Krikorian RK, Vacek JL, Beauchamp GD. Timing, mode, and predictors of death after direct angioplasty for acute myocardial infarction. Cath Cardiovasc Diag. 1995;35(3):192-6.

  • 7. Grines CL, Cox DA, Stone GW, Garcia E, Mattos LA, Giambartolomei A, et al. Coronary angioplasty with or without stent implantation for acute myocardial infarction. N Engl J Med. 1999;341(26):1949-56.

  • 8. Grines CL, Ellis S, Jones M, Grenfel L, Zijlstra F, Akhras F, et al. Primary coronary angioplasty vs thrombolytic therapy for acute myocardial infarction: longterm follow-up of 10 randomized trials. Circulation. 1999;100(Suppl I):1499.

  • 9. Lee KL, Woodlief LH, Topol EJ, Weaver WD, Betriu A, Col J, et al. Predictors of 30-day mortality in the era of reperfusion for acute myocardial infarction. Results from an international trial of 41,021 patients. GUSTO-I Investigators. Circulation. 1995;91(6):1659-68.

  • 10. Grines CL, Browne KF, Marco J, Rothbaum D, Stone GW, O'Keefe J, et al. A comparison of immediate angioplasty with thrombolytic therapy for acute myocardial infarction. The Primary Angioplasty in Myocardial Infarction Study Group. N Engl J Med. 1993;328(10):673-9.

  • 11. Sorajja S, Gersh BJ, Cox DA, McLaughlin MG, Zimetbaum P, Costantini C, et al. Impact of multivessel disease on reperfusion success and clinical outcomes in patients undergoing primary percutaneous coronary intervention for acute myocardial infarction. Eur Heart J. 2007;28(14):1709-16.

  • 12. Steg G, James SK, Atar D, Badano LP, Lundqvist CB, Borger MA, et al. ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J. 2012;33:2569-619.

  • 13. van der Schaaf RJ, Timmer JR, Ottervanger JP, Hoorntje JC, de Boer MJ, Suryapranata H, et al. Long-term impact of multivessel disease on cause-specific mortality after ST elevation myocardial infarction treated with reperfusion therapy. Heart. 2006;92(12):1760-3.

  • 14. Tarantini G, Napodano M, Gasparetto N, Favaretto E, Marra MP, Cacciavillani L, et al. Impact of multivessel coronary artery disease on early ischemic injury, late clinical outcome, and remodelling in patients with acute myocardial infarction treated by primary coronary angioplasty. Coron Artery Dis. 2010;21(2):78-86.

  • 15. DeGeare VS, Stone GW, Grines L, Brodie BR, Cox DA, Garcia E, et al. Angiographic and clinical characteristics associated with increased inhospital mortality in elderly patients with acute myocardial infarction undergoing percutaneous intervention (a pooled analysis of the primary angioplasty in myocardial infarction trial). Am J Cardiol. 2000;86(1):30-4.

  • 16. Jaski BE, Cohen JD, Traush J, Marsh DG, Bail GR, Overlie PA, et al. Outcome of urgent percutaneous coronary angioplasty in acute myocardial infarction: comparison of single-vessel versus multivessel coronary artery disease. Am Heart J. 1992;124(6):1427-33.

  • 17. De Luca G, Suprayanata H, Ottervanger JP, Antman EM. Time delay to treatment and mortality in primary angioplasty for acute myocardial infarction: every minute of delay counts. Circulation. 2004;109(10):1223-5.

  • 18. Faerman I, Faccio E, Milei J, Nuñez R, Jadzinsky M, Fox D, et al. Autonomic neuropathy and painless myocardial infarction in diabetic patients. Histologic evidence of their relationship. Diabetes. 1977;26(12):1147-58.

  • 19. Mehta RH, Ruane TJ, McCargar PA, Eagle KA, Stalhandske EJ. The treatment of elderly diabetic patients with acute myocardial infarction: insight from Michigan's Cooperative Cardiovascular Project. Arch Intern Med. 2000;160(9):1301-6.


Journal + Issues