Importance of complete revascularization in patients with acute myocardial infarction treated with percutaneous coronary intervention Zbigniew Kalarus, MD, a Radosl = aw Lenarczyk, MD, a Jacek Kowalczyk, MD, a Oskar Kowalski, MD, a Mariusz Ga˛sior, MD, b Tomasz Wa˛s, MD, a Tadeusz Ze S bik, MD, b Hubert Krupa, MD, a Piotr Chodo ´r, MD, a Lech Polon ´ ski, MD, PhD, b and Marian Zembala, MD, PhD c Zabrze, Poland Background The role of incomplete revascularization (ICR) in patients with acute myocardial infarction (AMI) is controversial. We evaluated the impact of ICR on short- and long-term outcome in patients with AMI and multivessel disease (MVD) treated with percutaneous coronary interventions (PCI) during index hospital stay. Methods Single-center observational study covered 798 patients with MVD selected from 1486 consecutive patients with AMI treated with PCI. At discharge, 605 (75.8%) of the patients still had at least 1 diseased artery (ICR group); in 193, complete revascularization (CR) has been achieved (CR group). Any-cause mortality rate and major adverse cardiac events (MACE) during hospitalization, within a follow-up period of 30 days and 29.7 months, were compared between both groups in the whole population and within the high-risk subgroups. Propensity model to predict the probability of CR according to 16 variables was used. Results Mortality and MACE rates were significantly higher in ICR group than among completely revascularized subjects during short- and long-term observation (remote mortality 18.5% vs 7.2%, MACE 53.1% vs 24.3%, both P b .001). Higher mortality rate was also observed within the subgroups with diabetes (25.2% vs 4.8%), renal dysfunction (44.1% vs 13.8%), and lowered ejection fraction (26.5% vs 10.5%, all P b .05). Propensity-adjusted multivariate analysis showed that ICR was a significant and strong predictor of remote death (propensity-adjusted hazard ratio 2.01, 95% CI 1.71-2.31, P = .02) and MACE (hazard ratio 2.08, 95% CI 1.90-2.26, P b .001). Conclusions Incomplete revascularization is a strong and independent risk factor of death and MACE in patients with AMI treated with PCI. (Am Heart J 2007;153:304212.) In the last decade, percutaneous coronary interven- tions (PCI) have become an important method in the treatment of patients with acute myocardial infarction (AMI). Although the presence of multivessel coronary artery disease is diagnosed in as many as 30% to 60% of patients with AMI, PCI is usually confined to the infarct- related artery (IRA). 1 Some studies of patients with stable coronary artery disease showed better long-term outcome in the groups with complete (CR) rather than incomplete revascularization (ICR); however, these results were not confirmed by other studies. 2-4 There- fore, the role of CR in acute coronary syndromes, especially in the patients with AMI, remains controver- sial. 1,5,6 Indeed, the role of CR remains unclear in the subgroups that are at high risk for death because of the episode of AMI, such as patients with low ejection fraction (EF), diabetes mellitus (DM), renal insufficiency, and advanced age (AA), in whom every intervention, which could improve the outcome, is of crucial importance. Therefore, the aim of the study was to evaluate the impact of ICR on short- and long-term outcome in patients with AMI and multivessel disease (MVD) treated with PCI during index hospital stay. Methods Data acquisition The clinical data from all patients with AMI and MVD were prospectively recorded in a computerized database as a part of From the a First Department of Cardiology, Silesian Medical School, Silesian Center for Heart Disease, Zabrze, Poland, b Third Department of Cardiology, Silesian Medical School, Silesian Center for Heart Disease, Zabrze, Poland, and c Department of Cardiac Surgery and Transplantology, Silesian Medical School, Silesian Center for Heart Disease, Zabrze, Poland. The study data were partly presented at the Scientific Sessions of the American Heart Association, New Orleans, LA, November 7 to 10, 2004, and Dallas, TX, November 13 to 16, 2005. Submitted May 8, 2006; accepted October 28, 2006. Reprint requests: Zbigniew Kalarus, MD, First Department of Cardiology, Silesian Medical School, Silesian Center for Heart Disease, ul. Szpitalna 2, 44-100 Zabrze, Poland. E-mail: elfizab@poczta.onet.pl 0002-8703/$ - see front matter n 2007, Mosby, Inc. All rights reserved. doi:10.1016/j.ahj.2006.10.033