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https://hdl.handle.net/2440/110985
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dc.contributor.author | Shanmugam, V. | - |
dc.contributor.author | Psaltis, P. | - |
dc.contributor.author | Wong, D. | - |
dc.contributor.author | Meredith, I. | - |
dc.contributor.author | Malaiapan, Y. | - |
dc.contributor.author | Ahmar, W. | - |
dc.date.issued | 2017 | - |
dc.identifier.citation | Heart Lung and Circulation, 2017; 26(10):1059-1068 | - |
dc.identifier.issn | 1443-9506 | - |
dc.identifier.issn | 1444-2892 | - |
dc.identifier.uri | http://hdl.handle.net/2440/110985 | - |
dc.description.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. | - |
dc.description.statementofresponsibility | Vimalraj Bogana Shanmugam, Peter J. Psaltis, Dennis T.L. Wong, Ian T. Meredith, Yuvaraj Malaiapan, Wally Ahmar | - |
dc.language.iso | en | - |
dc.publisher | Blackwell Publishing | - |
dc.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. | - |
dc.source.uri | http://dx.doi.org/10.1016/j.hlc.2016.12.006 | - |
dc.subject | Coronary aneurysm | - |
dc.subject | Coronary artery ectasia | - |
dc.subject | Ectatic infarct related artery | - |
dc.subject | Large thrombus burden | - |
dc.subject | Primary percutaneous coronary intervention | - |
dc.subject | ST-elevation myocardial infarction | - |
dc.title | Outcomes after primary percutaneous coronary intervention for ST-elevation myocardial infarction caused by ectatic infarct related arteries | - |
dc.type | Journal article | - |
dc.identifier.doi | 10.1016/j.hlc.2016.12.006 | - |
dc.relation.grant | NHMRC | - |
pubs.publication-status | Published | - |
dc.identifier.orcid | Psaltis, P. [0000-0003-0222-5468] | - |
Appears in Collections: | Aurora harvest 3 Medicine publications |
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