One-Year Outcomes After Primary Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction...

Area of Science:

• Cardiology
• Interventional Cardiology
• Medical Imaging

Background:

• Coronary artery calcium (CAC) is a known predictor of adverse events after percutaneous coronary intervention (PCI).
• Limited data exist on the long-term impact of angiographically evident CAC in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary PCI.

Purpose of the Study:

• To investigate the association between moderate-to-severe CAC and 1-year all-cause mortality in STEMI patients after primary PCI.
• To determine if CAC independently predicts long-term outcomes in this patient population.

Main Methods:

• Retrospective analysis of 2,143 consecutive STEMI patients undergoing primary PCI.
• Patients categorized by visual assessment of CAC: moderate-to-severe (n=306) vs. minimal-to-none (n=1,837).
• Primary endpoint: all-cause mortality at 1-year post-PCI, with multivariable adjustment for clinical and angiographic factors.

Main Results:

• Moderate-to-severe CAC was associated with older age, female sex, and comorbidities like hypertension and chronic kidney disease.
• Patients with moderate-to-severe CAC had higher rates of anterior MI, advanced Killip class, and poorer angiographic results.
• Unadjusted 1-year mortality was higher in the moderate-to-severe CAC group (8.5% vs. 4.7%, p=0.008).
• After adjustment, moderate-to-severe CAC was not an independent predictor of 1-year all-cause mortality.

Conclusions:

• Approximately 15% of STEMI patients undergoing primary PCI exhibit moderate-to-severe CAC.
• While associated with adverse clinical and angiographic features, advanced CAC is not an independent predictor of 1-year mortality in STEMI patients post-PCI.
• CAC may serve as a marker of overall cardiovascular risk in STEMI patients, but its independent prognostic value for mortality requires further investigation.