A score for decision making during percutaneous coronary intervention in acute myocardial infarction patients with multivessel disease

• Main Authors: Hae Chang Jeong, Joon Ho Ahn, Min Chul Kim, Doo Sun Sim, Keun Ho Park, Young Joon Hong, Ju Han Kim, Myung Ho Jeong, Ki-Bae Seung, Kiyuk Chang, Youngkeun Ahn
• Format: Article
• Language: English
• Published: The Korean Association of Internal Medicine 2019-03-01
• Series: The Korean Journal of Internal Medicine
• Subjects: percutaneous coronary intervention; myocardial infarction; prognosis
• Online Access: http://www.kjim.org/upload/pdf/kjim-2017-169.pdf

Background/Aims The optimal percutaneous coronary intervention (PCI) strategy in patients with acute myocardial infarction (AMI) with multivessel disease (MVD) is uncertain. This study was designed to develop a novel and simple tool for assessing an individualized and optimized PCI strategy in AMI patients with MVD. Methods In total, 5,025 patients with AMI from nine centers at two universities were enrolled in the prospective Convergent Registry of Catholic and Chonnam University for Acute Myocardial Infarction (COREA-AMI) registry from January 2004 through December 2009. From among them, we selected 2,630 patients with MVD who were treated by culprit-only or multivessel (MV) PCI. We investigated major adverse cardiac events (MACEs) during a 1-year clinical follow-up. Using a subgroup analysis, we extracted variables for use in the culprit only versus multivessel revascularization (CONVERSE) score, which showed a preference for MV PCI rather than culprit-only PCI for treating MVD. Results The CONVERSE score was constructed using eight independent variables (1 point for each variable): age > 65 years, hypertension, diabetes mellitus, high Killip class (III or IV), low left ventricular ejection fraction (≤ 50%), low creatinine clearance (≤ 60 mL/min), high level of high-sensitivity C-reactive protein (≥ 2.0 mg/L), and left anterior descending artery or left main as the nonculprit vessel. The incidence of MACEs increased linearly with the CONVERSE score. The receiver operating characteristic curve showed that the cutoff value was 3 points. Conclusions The results suggest that patients with a CONVERSE score of 3 or more should undergo MV PCI.