The impact of incomplete revascularization on early and late outcomes in ST-elevation myocardial infarction
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Published on: April 25, 2014
Sonya N Burgess1, John K French2, Tuan L Nguyen2
1Department of Cardiology, Liverpool Hospital, Sydney, New South Wales, Australia; The University of New South Wales, Sydney, New South Wales, Australia; Department of Cardiology, Nepean Hospital, Sydney, New South Wales, Australia.
Insights
In ST-elevation myocardial infarction (STEMI), incomplete revascularization significantly increases risks of cardiac death and myocardial infarction (MI). The residual Synergy Between PCI with TAXUS and Cardiac Surgery score (rSS) effectively predicts these adverse outcomes in STEMI patients.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Outcomes Research
Background:
- Lack of consensus exists on complete revascularization importance in ST-elevation myocardial infarction (STEMI) with multivessel disease.
- Timing of nonculprit stenosis treatment remains debated in STEMI patients.
- The residual Synergy Between PCI with TAXUS and Cardiac Surgery score (rSS) is proposed to define revascularization completeness.
Purpose of the Study:
- To investigate the impact of incomplete revascularization in STEMI patients.
- To assess the utility of the rSS score in defining revascularization completeness.
- To correlate rSS with adverse cardiovascular outcomes in STEMI.
Main Methods:
- Study included 589 consecutive STEMI patients with multivessel disease.
- Patients categorized by rSS: 0 (complete), 1-8 (incomplete, low residual disease), >8 (incomplete, high residual disease).
- Association between rSS categories and combined cardiac death/myocardial infarction (MI) analyzed.
Main Results:
- 25% had rSS=0, 42% rSS=1-8, 33% rSS>8.
- At 3.5-year follow-up, cardiac death/MI rates were 5% (rSS=0), 15% (rSS=1-8), and 26% (rSS>8) (P < .001).
- rSS was an independent predictor of cardiac death/MI and major adverse cardiovascular events.
Conclusions:
- The rSS score independently predicts cardiac death and MI in STEMI patients.
- Higher rSS scores (>8) are associated with substantially increased rates of cardiac death or MI.
- rSS is a valuable tool for defining incomplete revascularization and predicting adverse outcomes in STEMI.
Background:
In ST-elevation myocardial infarction (STEMI) in patients with multivessel disease, there is a lack of consensus regarding the importance of complete revascularization and the timing of treatment of nonculprit stenoses. Our objective was to investigate the impact of incomplete revascularization in STEMI patients using the residual Synergy Between PCI with TAXUS and Cardiac Surgery score (rSS) to define completeness of revascularization.
Methods:
This study examined associations between incomplete revascularization, determined by the rSS, and the combined outcome of cardiac death and myocardial infarction (MI). Patients were divided into groups: rSS = 0 (complete revascularization), rSS = 1-8 (incomplete revascularization with a low burden of residual disease), or rSS >8 (incomplete revascularization with a high burden of residual disease).
Results:
The rSS score was calculated in 589 consecutive patients; 25% had an rSS of 0, 42% rSS 1-8, and 33% rSS >8. At median follow-up of 3.5 years, cardiac death and MI occurred in 5% of rSS = 0 patients, 15% rSS = 1-8, and 26% with rSS >8 (P < .001). The rSS was powerful independent predictor of cardiac death and MI (hazard ratio 5.05, CI 2.89-12.00, rSS >8 vs rSS 0, P < .001 and hazard ratio 2.96, CI 1.31-6.69, rSS = 1-8 vs rSS = 0, P = .009), respectively, and an independent predictor of mortality, MI, unplanned revascularization, and major adverse cardiovascular events.
Conclusions:
In patients with STEMI, the rSS independently predicts cardiac death and MI. Patients with an rSS >8 had substantially higher rates of cardiac death or MI. The rSS can be used to define incomplete revascularization in STEMI and predict adverse outcomes.
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