Recurrent events after acute ST-segment elevation myocardial infarction: predictors and features of plaque
Luca Di Vito1, Federico Di Giusto1, Filippo Bruscoli2
1Cardiology AST Mazzoni Hospital, Ascoli Piceno.
Insights
Recurrent coronary events (RCEs) affect patients after ST-segment elevation myocardial infarction (STEMI). Low HDL at admission and high LDL at 12 months predict RCEs, which are often due to plaque progression rather than stent failure.
Area of Science:
- Cardiology
- Interventional Cardiology
- Biomarkers
Background:
- Patients with ST-segment elevation myocardial infarction (STEMI) face a significant risk of recurrent coronary events (RCEs).
- Non-culprit plaque progression and stent failure are primary contributors to RCEs following STEMI.
- Identifying predictors of RCEs is crucial for improving patient outcomes.
Purpose of the Study:
- To determine the incidence of RCEs in patients treated for STEMI.
- To identify clinical and biochemical predictors of RCEs.
- To differentiate the causes and timing of RCEs.
Main Methods:
- A cohort of 830 patients with STEMI was followed for 5 years.
- Blood samples were analyzed at admission, 1 month, and 12 months post-procedure.
- Patients were categorized into RCE and control groups, with RCEs further classified by cause (plaque progression vs. stent failure).
Main Results:
- The incidence of RCEs was 7.6% (63 patients) over 5 years.
- Low HDL at admission and high LDL at 12 months were independently associated with RCEs.
- Non-culprit plaque progression (47.6%) was a more frequent cause of RCEs than stent failure (36.5%), with RCEs from plaque progression occurring later.
Conclusions:
- Recurrent coronary events remain a significant concern for STEMI patients post-percutaneous coronary intervention (pPCI).
- Low admission HDL and elevated 12-month LDL levels are significant predictors of RCEs.
- RCEs attributed to non-culprit plaque progression manifest later than those due to stent failure.
Objectives:
Patients with acute ST-segment elevation myocardial infarction (STEMI) are at high risk for recurrent coronary events (RCE). Non-culprit plaque progression and stent failure are the main causes of RCEs. We sought to identify the incidence and predictors of RCEs.
Methods:
Eight hundred thirty patients with STEMI were enrolled and followed up for 5 years. All patients underwent blood test analysis at hospital admission, at 1-month and at 12-month follow-up times. Patients were divided into RCE group and control group. RCE group was further categorized into non-culprit plaque progression and stent failure subgroups.
Results:
Among 830 patients with STEMI, 63 patients had a RCE (7.6%). At hospital admission, HDL was numerically lower in RCE group, while LDL at both 1-month and 12-month follow-up times were significantly higher in RCE group. Both HDL at hospital admission and LDL at 12-month follow-up were independently associated with RCEs (OR 0.90, 95% CI 0.81-0.99 and OR 1.041, 95% CI 1.01-1.07, respectively). RCEs were due to non-culprit plaque progression in 47.6% of cases, while in 36.5% due to stent failure. The mean time frame between pPCI and RCE was significantly greater for non-culprit plaque progression subgroup as compared to stent failure subgroup (27 ± 18 months and 16 ± 14 months, P = 0.032).
Conclusion:
RCEs still affect patients after pPCI. Low levels of HDL at admission and high levels of LDL at 12 months after pPCI significantly predicted RCEs. A RCE results in non-culprit plaque progression presents much later than an event due to stent failure.
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