Key result
LAD and LCx culprit vessels in STEMI patients were associated with a higher risk of 1-year mortality, heart failure, and stroke compared with RCA infarctions.
Why the study?
Does the culprit vessel location impact mortality and clinical outcomes in previously cardiac healthy patients undergoing primary PCI for STEMI?
Cohort (n=29,832)
Yes
Does the culprit vessel location impact mortality and clinical outcomes in previously cardiac healthy patients undergoing primary PCI for STEMI?
In patients with STEMI undergoing primary PCI, LAD and LCx culprit vessels are associated with higher short-term mortality and complications compared to RCA, though the mortality difference is largely driven by events within the first 30 days.
Answers are grounded in this paper and cite their sources.
May refine post-STEMI risk stratification by culprit vessel; leaves open whether vessel-targeted therapies alter outcomes.
Background: ST-elevation myocardial infarction (STEMI) occurs as a result of rupture of an atherosclerotic plaque in the coronary arteries. Limited data exist regarding the impact of culprit coronary vessel on hard clinical event rates. This study investigated the impact of culprit vessel on outcomes after primary percutaneous coronary intervention (PCI) of STEMI. Methods: A total of 29 832 previously cardiac healthy patients who underwent primary PCI between 2003 and 2014 were prospectively included from the Swedish Coronary Angiography and Angioplasty Registry and the Registry of Information and Knowledge about Swedish Heart Intensive care Admissions. Patients were stratified into three groups based on culprit vessel (right coronary artery (RCA), left anterior descending artery (LAD) and left circumflex artery (LCx)). The primary outcome was 1-year mortality. The secondary outcomes included 30-day and 5-year mortality, as well as heart failure, stroke, bleeding and myocardial reinfarction at 30 days, 1 year and 5 years. Univariable and multivariable analyses were done using Cox regression models. Results: One-year analyses revealed that LAD infarctions had the highest increased risk of death, heart failure and stroke compared with RCA infarctions, which had the lowest risk. Sensitivity analyses revealed that reduced left ventricular ejection fraction on discharge partially explained this increased relative risk in mortality. Furthermore, landmark analyses revealed that culprit vessel had no significant influence on 1-year mortality if a patient survived 30 days after myocardial infarction. Subgroup analyses revealed female sex and multivessel disease (MVD) as significant high-risk groups with respect to 1-year mortality. Conclusions: LAD and LCx infarctions had a relatively higher adjusted mortality rate compared with RCA infarctions, with LAD infarctions in particular being associated with an increased risk of heart failure, stroke and death. Culprit vessel had limited influence on mortality after 1 month. High-risk patient groups include LAD infarctions in women or with concomitant MVD.
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Entezarjou et al. (2018) conducted a cohort in ST-elevation myocardial infarction (STEMI) (n=29,832). LAD or LCx culprit vessel vs. RCA culprit vessel was evaluated on 1-year mortality. LAD and LCx culprit vessels in STEMI patients were associated with a higher risk of 1-year mortality, heart failure, and stroke compared with RCA infarctions.
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