Outcomes After Primary Percutaneous Coronary Intervention for ST-Elevation Myocardial Infarction Caused by Ectatic Infarct Related Arteries.
Heart Lung Circ
; 26(10): 1059-1068, 2017 Oct.
Article
in En
| MEDLINE
| ID: mdl-28216061
ABSTRACT
BACKGROUND:
There is minimal published data on outcomes of patients presenting with ST elevation myocardial infarction (STEMI) due to an ectatic infarct-related artery (EIRA). The aim of this study was to analyse the clinical characteristics and outcomes of these patients presenting for primary percutaneous coronary intervention (P-PCI) in comparison with non-EIRA.METHODS:
Of the 1834 patients who presented at our institution for P-PCI between February 2008 and November 2013, 25 (1.4%) were identified as having an EIRA. These patients were compared with those with non-EIRA (80 patients) who were age, gender and lesion matched. Further sub-group analysis on in-hospital and long-term outcomes was done comparing EIRA stented and non-stented patients. Clinical events evaluated include death, recurrent infarction, unstable angina, or target lesion revascularisation (TLR).RESULTS:
Baseline characteristics were similar between patients with EIRA and non-EIRA although none of those with EIRA had diabetes mellitus. By comparison to the non-EIRA group, the major procedural differences for patients with EIRA were (1) a greater incidence of large thrombus burden (96.0% vs 22.5%, p=0.0001), (2) increased usage of peri-procedural glycoprotein IIb/IIIa inhibitors (72.0% vs 37.5%, p=0.01) and post-procedural anticoagulation (28.0% vs 5.0%, p=0.004), (3) larger mean stent dimension (3.9±0.8mm vs 3.4±0.6mm, p=0.04) and (4) a higher percentage of P-PCI cases that did not have stent deployment (44.0% vs 7.5%, p=0.0001). Patients with STEMI from EIRA had similar in-hospital outcomes but a higher long-term incidence of composite cardiovascular events at mean follow-up of 36.6±14.1months (44.0% vs 16.3% for non-EIRA, p=0.01). Although patients with EIRA who received stenting had better in-hospital outcomes than the non-stented cohort (composite cardiovascular event rate 0.0% vs 36.4%, p=0.03), long-term outcomes were comparable (35.7% vs 54.6%, p=0.59) due to a relatively high frequency of non-fatal MI and unstable angina in both groups.CONCLUSION:
Patients with STEMI due to EIRA carry worse long-term outcomes than those with non-EIRA. While successful stent deployment in the setting of EIRA improves procedural and inpatient success rates, it does not necessarily convey benefit to long-term event rates due to recurrent acute coronary syndromes.Key words
Full text:
1
Database:
MEDLINE
Main subject:
Coronary Vessel Anomalies
/
Coronary Vessels
/
Percutaneous Coronary Intervention
/
ST Elevation Myocardial Infarction
Type of study:
Diagnostic_studies
/
Etiology_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limits:
Female
/
Humans
/
Male
/
Middle aged
Language:
En
Journal:
Heart Lung Circ
Journal subject:
ANGIOLOGIA
/
CARDIOLOGIA
Year:
2017
Type:
Article