August 1, 2006Journal of Interventional Cardiology
Does Proximal Location of Culprit Lesion Confer Worse Prognosis in Patients Undergoing Primary Percutaneous Coronary Intervention for ST Elevation Myocardial Infarction?
Why the study?
Does proximal location of culprit lesion confer worse prognosis in STEMI patients undergoing primary PCI?
Population
3,535 STEMI patients with native coronary artery occlusion undergoing primary percutaneous coronary…
Comparison
Proximal culprit lesion (n = 1,606) vs Non-proximal culprit lesion (n = 1,929)
Design
Cohort
Follow-up
1 year
Authors
Discussion
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Member takes
Implication
May warrant closer monitoring in proximal culprit STEMI; leaves open whether lesion location should guide management.
Key Points
- To evaluate whether a proximal culprit lesion location confers a worse short- and long-term prognosis in patients with STEMI undergoing primary percutaneous coronary intervention.
- Pooled retrospective analysis of 3,535 STEMI patients with native coronary artery occlusion from the Primary Angioplasty in Myocardial Infarction database.
- Compared in-hospital and 1-year clinical outcomes between patients with proximal (n = 1,606) versus non-proximal (n = 1,929) culprit lesions.
- Adjusted for baseline differences to assess the independent prognostic impact on mortality, major adverse cardiovascular events (MACE), ventricular arrhythmias, and sustained hypotension.
- Proximal culprit lesions showed higher unadjusted in-hospital mortality (3.8% vs 2.2%, P = 0.006) and MACE (8.2% vs 5.8%, P = 0.0066), as well as higher 1-year mortality (6.9% vs 4.5%, P = 0.0013) and 1-year MACE (22% vs 17%, P = 0.003).
- After adjustment, proximal location remained an independent predictor of in-hospital death (adjusted OR 1.58, 95% CI 1.05–2.40) and in-hospital MACE (adjusted OR 1.41, 95% CI 1.06–1.86), but was not predictive at 1 year.
- Proximal culprit lesions were independently associated with higher rates of ventricular arrhythmias and sustained hypotension during the initial hospital stay.
Structured PICO
Does proximal location of culprit lesion confer worse prognosis in STEMI patients undergoing primary PCI?
P
Population
3,535 STEMI patients with native coronary artery occlusion undergoing primary percutaneous coronary intervention (PCI), pooled from the primary angioplasty in myocardial infarction database.
I
Intervention
Proximal culprit lesion (n = 1,606)
C
Comparator
Non-proximal culprit lesion (n = 1,929)
O
Outcome
In-hospital death and major adverse cardiovascular events (MACE)hard clinical
In STEMI patients undergoing primary PCI, a proximal culprit lesion is an independent predictor of worse in-hospital mortality and MACE.
Cite This Study
Harjai et al. (2006) studied this question.