Why the study?
The long-term durability of primary PCI in terms of target lesion failure remains unknown in STEMI patients.
One in five STEMI patients treated with primary PCI experiences target lesion failure within 10 years, highlighting a sustained annual risk of 1.6% beyond the first year.
BACKGROUND: Primary percutaneous coronary intervention (PCI) has significantly improved outcomes for ST-segment elevation myocardial infarction (STEMI) patients. However, the long-term durability of PCI in terms of target lesion failure (TLF) remains unknown. OBJECTIVES: This study investigates the long-term incidence, predictors and clinical impact of TLF over a 10-year follow-up in STEMI patients treated with primary PCI. METHODS: From the DANAMI-3 trial, we analysed STEMI patients treated with primary PCI. TLF was defined as a composite of cardiovascular death, target lesion myocardial infarction or target lesion revascularisation. Independent predictors of TLF were identified by Cox regression. Outcomes in high-risk and low-risk groups were evaluated using cumulative incidence functions with competing risk analysis. RESULTS: Of 2217 patients (median follow-up of 10.7 years), 443 (20.0%) experienced TLF. TLF occurred in 5.6% within the first year after PCI and continued at a constant annual rate of 1.6% thereafter. All-cause mortality, any MI or any revascularisation occurred in 961 (43%) patients, and TLF constitutes 46% of the total patient-oriented events. Multivariable Cox regression identified age, hypertension, previous AMI and Killip class II-IV as independent predictors of an increased risk of TLF, whereas PCI with drug-eluting stents was associated with a reduced risk of TLF. Patients with ≥1 high-risk feature had a twofold greater risk of TLF compared with those without (HR 2.05, 95% CI 1.65 to 2.55, p<0.001). CONCLUSIONS: One in five STEMI patients treated with primary PCI experiences TLF within 10 years, accounting for a significant proportion of any mortality, any MI or any revascularisation, with sustained occurrence rates beyond the first year. TRIAL REGISTRATION NUMBER: NCT01960933.
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Özbek et al. (2025) studied this question.
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