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Long-term outcomes of patients sent emergently to the catheterization laboratory for possible primary percutaneous

Tyson E Turner1, Stephen W Waldo, Ameya Kulkarni

  • 1Department of Medicine, University of California, San Francisco, San Francisco, California.

The American Journal of Cardiology
|September 26, 2013
PubMed

Insights

Patients undergoing primary percutaneous coronary intervention for ST-segment elevation myocardial infarction (STEMI) without a culprit lesion have similar major adverse cardiovascular events (MACE) rates as those with a culprit lesion. This finding impacts STEMI treatment strategies.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Clinical Outcomes Research

Background:

  • Current guidelines recommend primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI).
  • Outcomes for STEMI patients without a culprit lesion after PCI referral are not well-established.
  • This study addresses a gap in understanding cardiovascular events in this specific patient group.

Purpose of the Study:

  • To compare the cardiovascular outcomes of patients with ST-segment elevation myocardial infarction (STEMI) who underwent emergent angiography.
  • Specifically, to evaluate outcomes in patients with no coronary artery disease (CAD), CAD without a culprit lesion, and CAD with a culprit lesion.
  • To assess the relationship between angiographic findings and major adverse cardiovascular events (MACE) and mortality.

Main Methods:

  • Retrospective analysis of a registry of patients undergoing emergent angiography for presumed STEMI (October 2008 - July 2012).
  • Patients categorized into three groups: no CAD, CAD without culprit lesion, and CAD with culprit lesion.
  • Cox proportional hazards models and Kaplan-Meier analyses were used to evaluate MACE and mortality.

Main Results:

  • Of 539 patients, 12% had no CAD, 20% had CAD without a culprit lesion, and 68% had a culprit lesion.
  • Patients with CAD without a culprit lesion had similar MACE rates to those with a culprit lesion (p=0.64).
  • Both groups with CAD had significantly increased MACE risk compared to those with no CAD (HR 1.9-2.0). A nonsignificant trend toward increased mortality was observed in CAD groups.

Conclusions:

  • Patients with coronary artery disease (CAD) but no culprit lesion identified during emergent angiography for presumed ST-segment elevation myocardial infarction (STEMI) experience similar long-term major adverse cardiovascular events (MACE) rates as those with a culprit lesion.
  • These findings suggest that the absence of a culprit lesion in STEMI patients does not negate long-term cardiovascular risk.
  • Further research may refine risk stratification and management strategies for STEMI patients without obstructive coronary artery disease.

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