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Published on: September 25, 2019
Association of lesion complexity following fibrinolytic administration with mortality in ST-elevation myocardial
C Michael Gibson1, Brian Bigelow, David James
1Department of Medicine, Brigham & Women's Hospital, Boston, Massachusetts 02115, USA. mgibson@timi.org
Insights
Greater lesion complexity in ST-segment elevation myocardial infarction patients treated with fibrinolysis is linked to worse outcomes. This includes poorer blood flow and a higher risk of shock and death within 30 days.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Research
Background:
- Complex coronary lesions are linked to lower success rates in percutaneous coronary intervention.
- Fibrinolytic therapy is a primary treatment for ST-segment elevation myocardial infarction (STEMI).
Purpose of the Study:
- To investigate if greater lesion complexity after fibrinolysis for STEMI is associated with increased 30-day mortality and adverse events.
- To evaluate the impact of lesion complexity on epicardial flow and myocardial perfusion post-fibrinolysis.
Main Methods:
- Analysis of 2,605 patients from four major studies (TIMI 10B, TIMI 14, ENTIRE, FASTER).
- Angiographic outcomes assessed immediately post-fibrinolysis.
- Clinical outcomes, including mortality and shock, evaluated at 30 days.
Main Results:
- Greater lesion complexity correlated with poorer epicardial flow and reduced myocardial perfusion.
- Patients with complex lesions had a higher risk of shock and 30-day mortality.
- Multivariate analysis confirmed that type C lesion complexity independently predicted increased 30-day mortality.
Conclusions:
- Lesion complexity is a significant predictor of adverse outcomes in STEMI patients treated with fibrinolysis.
- Identifying complex lesions early can help stratify risk and guide treatment strategies.
- Further research may explore tailored interventions for complex lesions in STEMI.
Abstract:
Greater lesion complexity, according to the American College of Cardiology and American Heart Association, has been associated with decreased success rates of percutaneous coronary intervention. We hypothesized that greater lesion complexity after fibrinolytic administration for ST-segment elevation myocardial infarction would similarly be associated with increased mortality and other adverse events at 30 days. We studies 2,605 patients from the Thrombolysis In Myocardial Infarction 10B and 14, Integrilin and Tenecteplase in Acute Myocardial Infarction, ENTIRE, and FASTER studies. For all studies, angiographic outcomes were assessed immediately after fibrinolytic administration and clinical outcomes were assessed at 30 days. Greater lesion complexity was associated with poorer epicardial flow and decreased myocardial perfusion at 60 minutes and after percutaneous coronary intervention and with a higher risk of shock and mortality within 30 days. In a multivariate model, type C lesion complexity remained associated with an increased 30-day mortality rate.
