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Ten-year prognostic impact of target versus non-target vessel failure after STEMI. Insight from the
Filippo Maria Verardi1, Kamil Bujak2, Paolo Tolomeo3
1Institut Clínic Cardiovascular, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Hospital Clínic, Barcelona, Spain; Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara, Cona, Italy.
Insights
Long-term outcomes after ST-segment myocardial infarction (STEMI) depend on factors like age and diabetes. The type of initial adverse event, whether target vessel failure (TVF) or non-TVF, did not significantly impact subsequent patient-oriented composite endpoints (POCE).
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Research
Background:
- Prognostic impact of adverse events post-ST-segment myocardial infarction (STEMI) is not fully understood.
- Long-term outcomes require evaluation beyond initial treatment.
Purpose of the Study:
- Identify very long-term predictors of patient-oriented composite endpoints (POCE) after STEMI.
- Determine if the first adverse event type (target vessel failure vs. non-target vessel failure) influences subsequent outcomes.
Main Methods:
- Analysis of the EXAMINATION-EXTEND trial data with 10-year follow-up.
- Randomized STEMI patients to everolimus-eluting stents vs. bare-metal stents.
- Evaluated predictors of POCE (all-cause death, myocardial infarction, revascularization) and compared outcomes based on the first event type.
Main Results:
- 35.3% of 1498 STEMI patients experienced a POCE over 10 years.
- Independent POCE predictors included age, diabetes, prior myocardial infarction, peripheral arterial disease, and multivessel coronary disease.
- No significant difference in subsequent POCE between target vessel failure-first and non-target vessel failure-first groups.
Conclusions:
- Age, diabetes, and extent of atherosclerotic disease are key predictors of long-term POCE after STEMI.
- The nature of the initial event (TVF or non-TVF) does not appear to affect subsequent long-term prognosis.
- Findings highlight the importance of managing comorbidities for improved STEMI patient outcomes.
Introduction And Objectives:
After ST-segment myocardial infarction (STEMI), the impact of different adverse events on prognosis remains unknown. We aimed to assess very long-term predictors of patient-oriented composite endpoints (POCE) and investigate whether the occurrence of target vessel failure (TVF) vs a non-TVF event as the first event could potentially influence subsequent outcomes.
Methods:
The EXAMINATION-EXTEND trial randomized STEMI patients to receive either an everolimus-eluting stent or a bare-metal stent. The follow-up period was 10 years. Predictors of POCE (a composite of all-cause death, any myocardial infarction, or any revascularization) were evaluated in the overall study population. The patients were stratified based on the type of first event (TVF-first vs non-TVF-first) and were compared in terms of subsequent POCE. TVF was defined as a composite of cardiac death, TV myocardial infarction, or TV revascularization.
Results:
Out of the 1498 enrolled patients, 529 (35.3%) experienced a POCE during the 10-year follow-up. Independent predictors of POCE were age, diabetes mellitus, previous myocardial infarction, peripheral arterial disease, and multivessel coronary disease. The first event was a TVF in 296 patients and was a non-TVF in 233 patients. No significant differences were observed between TVF-first and non-TVF-first patients in terms of subsequent POCE (21.7% vs 39.3%, time ratio 1.79; 95%CI, 0.87-3.67;P=.12) or its individual components.
Conclusions:
At the 10-year follow-up, approximately one-third of STEMI patients had experienced at least 1 POCE. Independent predictors of these events were age, diabetes, and more extensive atherosclerotic disease. The occurrence of a TVF or a non-TVF as the first event did not seem to influence subsequent outcomes.
Trial Registration Number:
NCT04462315.
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