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Published on: April 25, 2014
Effect of infarct site on the clinical endpoints of thrombolytic-treated ST-elevation myocardial infarction
Kristina Gifft1, Mary Dohrmann2, Mohammad Eniezat3
1Department of General Medicine, University of Missouri Health Care, Columbia, MO, USA.
Insights
Thrombolytic therapy for ST-elevation myocardial infarction (STEMI) in the right coronary artery (RCA) distribution shows better outcomes. Patients experienced lower mortality, less cardiogenic shock, and shorter hospital stays compared to LAD or LCX STEMI.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Research
Background:
- Some studies indicate superior outcomes for thrombolysis in inferior ST-elevation myocardial infarction (STEMI).
- The impact of coronary artery distribution on STEMI outcomes following thrombolytic therapy requires further investigation.
Purpose of the Study:
- To compare clinical endpoints of thrombolytic-treated STEMI based on coronary artery distribution.
- To evaluate mortality, length of stay, cardiogenic shock, and mechanical complications in STEMI patients treated with thrombolytics.
Main Methods:
- Retrospective analysis of the 2014 Nationwide Readmissions Data.
- Identification of STEMI cases treated with thrombolysis using ICD-9-CM codes.
- Comparison of in-hospital mortality, LOS, cardiogenic shock, and mechanical complications across LAD, LCX, and RCA distributions.
Main Results:
- STEMI in the right coronary artery (RCA) distribution (n=676) showed significantly lower mortality (3.6%), cardiogenic shock (7.7%), and shorter LOS (3.6 days) compared to LAD (n=431) and LCX (n=124) distributions.
- Mortality rates were 6.5% for LAD and 5.7% for LCX.
- Mechanical complications did not differ significantly across the coronary artery distributions (p=0.17).
Conclusions:
- Thrombolytic-treated STEMIs in the RCA distribution are associated with improved in-hospital outcomes.
- Lower mortality, reduced incidence of cardiogenic shock, and shorter hospital stays are observed in RCA STEMIs.
- Coronary artery distribution does not significantly impact mechanical complication rates in thrombolytic-treated STEMI.
Introduction:
Some studies suggest better outcomes after the use of thrombolytics in inferior ST-elevation myocardial infarction (STEMI) compared to other locations. The goal of this study is to compare the clinical endpoints of thrombolytic-treated STEMI based on coronary artery distribution.
Methods:
The study population was extracted from the 2014 Nationwide Readmissions Data using the International Classification of Diseases, Ninth Revision, Clinical Modifications codes for STEMI, thrombolytic infusion, and complications of STEMI. Primary study endpoints included in-hospital all-cause mortality, length of hospital stay (LOS), cardiogenic shock, and mechanical complications of STEMI.
Results:
A principal diagnosis of thrombolytic-treated STEMI was identified for in 1231 patients (mean age 61.5 years; 26.5% female). Four hundred and thirty-one STEMIs occurred in the left anterior descending (LAD) artery distribution, 124 in the left circumflex (LCX) artery distribution, and 676 in the right coronary artery (RCA) distribution. In comparison to the LAD and LCX distributions, thrombolytic-treated STEMIs in the RCA distribution were associated with lower mortality (6.5% with LAD, 5.7% with LCX, and 3.6% with RCA; p = 0.02), fewer cardiogenic shock (12.3% with LAD, 12.1% with LCX, and 7.7% with RCA; p = 0.01), and shorter LOS (4.5 days with LAD, 3.9 with LCX, and 3.6 days with RCA; p < 0.01). Mechanical complications showed no significant difference based on coronary distribution (2.3% with LAD, 3.2% with LCX, and 1.2% with RCA; p = 0.17).
Conclusions:
Thrombolytic-treated STEMIs in the RCA distribution were associated with lower in-hospital all-cause mortality, cardiogenic shock, and shorter LOS. Mechanical complications were not different based on coronary distribution.
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