Long-term impact of multivessel disease on cause-specific mortality after ST elevation myocardial infarction treated with reperfusion therapy

R J van der Schaaf¹, J R Timmer¹, J P Ottervanger¹, J C A Hoorntje¹, M-J de Boer¹, H Suryapranata¹, F Zijlstra², J-H E Dambrink¹

¹ Department of Cardiology, Isala klinieken, locatie Weezenlanden, Zwolle, The Netherlands
² Department of Cardiology, Thoraxcenter, University Medical Center, Groningen, The Netherlands

Correspondence to:
Dr Jan-Henk E Dambrink
Isala klinieken, locatie Weezenlanden, Department of Cardiology, Groot Wezenland 20, 8011 JW Zwolle, The Netherlands; v.r.c.derks{at}isala.nl

Objectives: To investigate the long-term impact of multivessel coronary artery disease (MVD) on cause-specific mortality in patients with ST elevation myocardial infarction (STEMI) treated with reperfusion therapy.

Methods and results: Patients with STEMI (n = 395) treated with primary angioplasty or thrombolysis in the setting of a randomised clinical trial were enrolled in the study. Follow up was 8 (2) years. For patients who died all available records were reviewed to assess the specific cause of death. MVD was present in 57% of patients. Patients with MVD were older and more of them had diabetes and previous myocardial infarction. Compared with the non-MVD group, residual left ventricular ejection fraction was lower (45.9% v 49.6%, p = 0.001) and total mortality was higher in patients with MVD (32% v 19%, p = 0.002). After adjustment for potential confounders this association was not significant (hazard ratio 1.4, 95% confidence interval (CI) 0.9 to 2.2). When the specific cause of death was considered, sudden death was comparable between patients with and without MVD (10% v 8%, p = 0.49) but death caused by heart failure was significantly higher in patients with MVD (hazard ratio 7.4, 95% CI 1.7 to 32.2).

Conclusion: Patients with STEMI and MVD have a higher long-term mortality than do patients with non-MVD. MVD is not an independent predictor of long-term total mortality or sudden death. However, MVD is a very strong and independent predictor of long-term death caused by heart failure.

Abbreviations: HR, hazard ratio; LVEF, left ventricular ejection fraction; MVD, multivessel disease; PCI, percutaneous coronary intervention; STEMI, ST elevation myocardial infarction

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