Long-term results of delayed endovascular treatment of acute ST-segment elevation myocardial infarction in patients with ectasia of infarct-related coronary artery

Objective. To evaluate the safety, short-term and long-term outcomes after delayed and early stenting in patients with acute ST-segment elevation myocardial infarction and ectasia of infarct-related coronary artery. Material and methods. A multiple-center retrospective study included 80 patients with ST-segment elevation myocardial infarction and ectasia of infarct-related coronary artery between 2014 and 2022. Of these, 50 patients underwent immediate stenting, and 30 patients underwent delayed intervention. Results. Delayed stenting for acute ST-segment elevation myocardial infarction in patients with ectasia of infarct-related coronary artery improves reperfusion data, such as TIMI grade of epicardial coronary blood flow (p=0.02) and myocardial perfusion (MBG grade) (p<0.001). The same was true for combined angiographic endpoint TIMI-3 and MBG 2-3 (p=0.005), as well as ST segment resolution ≥70% (p=0.022). After 59 months, the incidence of adverse cardiovascular events was lower after delayed endovascular intervention (p=0.047). This was mainly due to lower risk of hospitalization for CHF (p=0.036) and recurrent myocardial infarction (p=0.179). Conclusion. Delayed endovascular treatment is safe in patients with acute ST-segment elevation myocardial infarction and ectasia of infarct-related coronary artery. This strategy is also associated with lower risk of adverse cardiovascular events in long-term period, mainly due to lower incidence of hospitalizations for chronic heart failure.