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Published on: May 28, 2019
Outcomes of Primary Percutaneous Intervention for ST-Segment Elevation Myocardial Infarction With Versus Without
Abhishek Chaturvedi1, Hector M Garcia-Garcia1, Matteo Cellamare2
1Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington DC.
Insights
Spontaneous coronary artery dissection (SCAD) patients with ST-elevation myocardial infarction (STEMI) experienced higher inpatient mortality and costs after primary percutaneous coronary interventions (PPCI) compared to non-SCAD patients. These concerning trends persist, highlighting the need for further research.
Area of Science:
- Cardiology
- Interventional Cardiology
- Acute Coronary Syndromes
Background:
- Spontaneous coronary artery dissection (SCAD) is a growing cause of acute coronary syndrome (ACS).
- Optimal revascularization strategies for SCAD-related ST-elevation myocardial infarction (STEMI) remain unclear.
- Prior international data suggested comparable outcomes between SCAD and non-SCAD patients undergoing primary percutaneous coronary intervention (PPCI).
Purpose of the Study:
- To evaluate inpatient mortality and healthcare utilization for SCAD versus non-SCAD patients with STEMI undergoing PPCI in a contemporary US cohort.
- To assess trends in outcomes for SCAD-STEMI patients over the past five years.
Main Methods:
- Retrospective analysis of a contemporary US cohort.
- Comparison of inpatient mortality, hospitalization duration, and costs between SCAD and non-SCAD patients with STEMI treated with PPCI.
Main Results:
- SCAD patients exhibited higher inpatient mortality following PPCI for STEMI compared to non-SCAD patients.
- The SCAD cohort experienced prolonged hospitalizations and increased hospitalization costs.
- These disparities in outcomes have remained consistent over the last five years.
Conclusions:
- SCAD patients with STEMI treated with PPCI face worse inpatient outcomes and higher costs than non-SCAD patients.
- Findings challenge previous international data and underscore the need for cautious consideration of PPCI in SCAD-STEMI.
- Further research, particularly prospective studies, is essential to clarify the role and optimal timing of PPCI in SCAD-STEMI management.
Abstract:
Spontaneous coronary artery dissection (SCAD) is an increasingly recognized cause of acute coronary syndrome, but there is no clear consensus on the choice and timing of revascularization strategy. Recent data from outside the United States suggested similar inpatient mortality after primary percutaneous coronary interventions (PPCI) in patients presenting with ST-elevation myocardial infarction (STEMI) secondary to SCAD versus non-SCAD. Utilizing similar methodologies in a contemporary US cohort, we found that SCAD patients had higher inpatient mortality after PPCI for STEMI compared with non-SCAD patients. We also found that the SCAD group had prolonged hospitalization and hospitalization costs compared with on-SCAD patients. Furthermore, these trends have not changed over the past 5 years. Our findings reiterate the need for continued discussion and research on the role and timing of PPCI in SCAD-STEMI patients in well-designed prospective cohorts.
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