Despite recommendations, nearly 14% of Medicare beneficiaries with STEMI undergo multi-vessel PCI

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.