Korean Circulation Journal

The Korean Society of Cardiology (대한심장학회)
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Impact of Complete Revascularization for Acute Myocardial Infarction In Multivessel Coronary Artery Disease Patients With Diabetes Mellitus

  • Jeehoon Kang (Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Sungjoon Park (Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Minju Han (Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Kyung Woo Park (Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Jung-Kyu Han (Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Han-Mo Yang (Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Hyun-Jae Kang (Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Bon-Kwon Koo (Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Hyo-Soo Kim (Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul National University College of Medicine)
  • Received : 2024.01.10
  • Accepted : 2024.05.01
  • Published : 2024.10.01
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Abstract

Background and Objectives: The clinical benefits of complete revascularization (CR) in acute myocardial infarction (AMI) patients are unclear. Moreover, the benefit of CR is unknown in AMI with diabetes mellitus (DM) patients. We sought to compare the prognosis of CR and incomplete revascularization (IR) in patients with AMI and multivessel disease, according to the presence of DM. Methods: A total of 2,150 AMI patients with multivessel coronary artery disease were analyzed. CR was defined based on the angiographic image. The primary endpoint of this study was the patient-oriented composite outcome (POCO) defined as a composite of all-cause death, any myocardial infarction, and any revascularization within 3 years. Results: Overall, 3-year POCO was significantly lower in patients receiving angiographic CR (985 patients, 45.8%) compared with IR (1,165 patients, 54.2%). When divided into subgroups according to the presence of DM, CR reduced 3-year clinical outcomes in the non-DM group but not in the DM group (POCO: 11.7% vs. 23.2%, p<0.001, any revascularization: 7.2% vs. 10.8%, p=0.024 in the non-DM group, POCO: 24.3% vs. 27.8%, p=0.295, any revascularization: 13.3% vs. 11.3%, p=0.448 in the DM group, for CR vs. IR). Multivariate analysis showed that CR significantly reduced 3-year POCO (hazard ratio, 0.52; 95% confidence interval, 0.36-0.75) only in the non-DM group. Conclusions: In AMI patients with multivessel disease, CR may have less clinical benefit in DM patients than in non-DM patients.

Keywords

Acknowledgement

This study was supported by grants from the Patient-Centered Clinical Research Coordinating Center (grant number: HI19C0481, HC19C0305) and from Seoul National University Hospital (30-2023-0300).

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