Please use this identifier to cite or link to this item:
https://hdl.handle.net/2440/110985
Citations | ||
Scopus | Web of Science® | Altmetric |
---|---|---|
?
|
?
|
Type: | Journal article |
Title: | Outcomes after primary percutaneous coronary intervention for ST-elevation myocardial infarction caused by ectatic infarct related arteries |
Author: | Shanmugam, V. Psaltis, P. Wong, D. Meredith, I. Malaiapan, Y. Ahmar, W. |
Citation: | Heart Lung and Circulation, 2017; 26(10):1059-1068 |
Publisher: | Blackwell Publishing |
Issue Date: | 2017 |
ISSN: | 1443-9506 1444-2892 |
Statement of Responsibility: | Vimalraj Bogana Shanmugam, Peter J. Psaltis, Dennis T.L. Wong, Ian T. Meredith, Yuvaraj Malaiapan, Wally Ahmar |
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 ± 0.8 mm vs 3.4 ± 0.6 mm, 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 ± 14.1 months (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. |
Keywords: | Coronary aneurysm Coronary artery ectasia Ectatic infarct related artery Large thrombus burden Primary percutaneous coronary intervention ST-elevation myocardial infarction |
Rights: | © 2017 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved. |
DOI: | 10.1016/j.hlc.2016.12.006 |
Grant ID: | NHMRC |
Published version: | http://dx.doi.org/10.1016/j.hlc.2016.12.006 |
Appears in Collections: | Aurora harvest 3 Medicine publications |
Files in This Item:
There are no files associated with this item.
Items in DSpace are protected by copyright, with all rights reserved, unless otherwise indicated.