Infarct-related artery and long-term mortality following recurrent ST-segment elevation myocardial infarction. Insights from a Polish nationwide registry - 08/12/22
, Jacek Niedziela, MD, PhD b, Piotr Desperak, MD, PhD b, Jacek Kwieciński, MD, PhD a, Maksymilian P. Opolski, Prof. a, Mariusz Gąsior, Prof. b, Adam Witkowski, Prof. aRiassunto |
Background |
Recurrent ST-segment elevation myocardial infarction (rSTEMI) can be attributed to the same (target-vessel, TV-rSTEMI) or different culprit vessel (non-target, nonTV-rSTEMI) compared with the first infarction. We hypothesized that long-term mortality after rSTEMI depends on the infarct-related artery (the same or different compared with the first STEMI).
Methods |
Using the Polish Registry of Acute Coronary Syndromes (PL-ACS) we retrospectively identified survivors of first STEMI treated with PCI who experienced rSTEMI. We divided rSTEMI into TV-rSTEMI and nonTV-rSTEMI. We compared clinical, angiographic, and procedural characteristics and utilized propensity score matching to adjust for baseline differences. Primary outcome was 1-, 3- and 5-year all-cause mortality.
Results |
Between 2003 and 2019 a total of 3,411 patients (mean age 63.7 years, 76% male) had rSTEMI, of whom 1,916 (56%) had TV-rSTEMI and 1,495 (44%) had nonTV-rSTEMI. Median time since first infarction was 716 days (100, 1,807). Patients with nonTV-rSTEMI had higher body mass index (27.2 vs 26.7 kg/m2, P = .041), more arterial hypertension (77.4 vs 73.7%, P = .015) and atrial fibrillation (4.8 vs 3.3%, P = .02), and lower left ventricular ejection fraction (43 [35, 50] vs 45 [38, 50]%, P <.001) compared with TV-rSTEMI. On coronary angiography nonTV-rSTEMI more frequently presented with Thrombolysis In Myocardial Infarction >1 flow (25.8 vs 15.7%, P < .001), multivessel disease (51.9 vs 40.8%, P =.002), culprit lesion located in circumflex artery (22.6 vs 5.6%, P < .001), and more frequently underwent stenting (88.8 vs 76.1%, P < .001) compared with TV-rSTEMI. There was no difference in unadjusted 1-, 3- and 5-year mortality between nonTV-rSTEMI and TV-rSTEMI. After propensity score analysis, 807 well-matched pairs of patients were selected. Adjusted 1-, 3- and 5-year mortality remained similar between nonTV-rSTEMI and TV-rSTEMI (14.7 vs 14.4%, P = .88; 23.6 vs 23.1%, P = .81; 30.0 vs 32.0%, P = .50 respectively).
Conclusions |
Our study shows overall low frequency of rSTEMI. Patients with nonTV-rSTEMI have different clinical and angiographic characteristics compared with TV-rSTEMI. No long-term mortality difference was observed between both groups.
Il testo completo di questo articolo è disponibile in PDF.Abbreviations : ACS, BMI, DES, GPI, IIb/IIIa, LAD, LCX, LMCA, MI, pPCI, RCA, rSTEMI, TIMI
Mappa
Vol 255
P. 31-38 - Gennaio 2023 Ritorno al numero
Articolo precedente
- On-treatment blood pressure and cardiovascular mortality in adults with repaired coarctation of aorta
- Alexander C. Egbe, William R. Miranda, Christopher Charles Jain, Heidi M. Connolly
- Diagnostic discrimination of a novel high-sensitivity cardiac troponin I assay and derivation/validation of an assay-specific 0/1h-algorithm
- Luca Koechlin, Jasper Boeddinghaus, Pedro Lopez-Ayala, Thomas Nestelberger, Desiree Wussler, Felix Mais, Raphael Twerenbold, Tobias Zimmermann, Karin Wildi, Anne Marie Köppen, Òscar Miró, F. Javier Martin-Sanchez, Damian Kawecki, Nicolas Geigy, Dagmar I. Keller, Michael Christ, Andreas Buser, Maria Rubini Giménez, Luca Bernasconi, Angelika Hammerer-Lercher, Christian Mueller, for the APACE investigators, Jeanne du Fay de Lavallaz, Joan Elias Walter, Michael Freese, Christian Puelacher, Ivo Strebel, Katharina Rentsch, Sandra Mitrovic, Danielle M. Gualandro, Nicolas Schaerli, Ana Yufera Sanchez, Bernhard Okamura, Samyut Shrestha, Beatriz López, Gemma Martinez-Nadal, Esther Rodriguez Adrada, Jiri Parenica, Arnold von Eckardstein, Beata Morawiec, Piotr Muzyk
Benvenuto su EM|consulte, il riferimento dei professionisti della salute.
L'accesso al testo integrale di questo articolo richiede un abbonamento.
Già abbonato a @@106933@@ rivista ?