Outcomes in Patients with ST-Elevation Myocardial Infarction According to Culprit Vessel - The 65th Annual Conference of the Israel Heart Society & The Israel Society of Cardiothoracic Surgery, 24-25 April 2018

Leor Perl Cardiology, Rabin Medical Center, Petach Tikva, Israel Hana Vaknin-Assa Cardiology, Rabin Medical Center, Petach Tikva, Israel Tamir Bental Cardiology, Rabin Medical Center, Petach Tikva, Israel Gabriel Greenberg Cardiology, Rabin Medical Center, Petach Tikva, Israel David Hasdai Cardiology, Rabin Medical Center, Petach Tikva, Israel Pablo Codner Cardiology, Rabin Medical Center, Petach Tikva, Israel Guy Witberg Cardiology, Rabin Medical Center, Petach Tikva, Israel Abed Samara Cardiology, Rabin Medical Center, Petach Tikva, Israel Ofer Sela Cardiology, Rabin Medical Center, Petach Tikva, Israel Eldad Rechavia Cardiology, Rabin Medical Center, Petach Tikva, Israel Ran Kornowski Cardiology, Rabin Medical Center, Petach Tikva, Israel Abid Assali Cardiology, Rabin Medical Center, Petach Tikva, Israel

Introduction:

Primary percutaneous coronary intervention (PPCI) is recommended in cases of ST-elevation myocardial infarction (STEMI), regardless of the culprit vessel. Little is known regarding the outcomes of these patients according to the culprit vessel.

Objectives:

To evaluate short and long-term outcomes of patients who present with STEMI and undergo PPCI, analyzed by the culprit artery.

Methods:

The study included 2,405 consecutive STEMI patients from the Rabin Medical Center prospective registry. The student`s t test was employed to compare numeric variables and chi-square was used for the categorical variables. Outcomes for mortality are reported for 1 month, and 2 years and major adverse cardiac events (MACE) at 3 years.

Results:

Mean age was 60.8±3.2. 433 (18%) of the patients were female, 614 (25.5%) had diabetes mellitus, 1,237 (51.4%) had hypertension and 175 (7.4%) suffered from renal failure. The culprit vessel was considered to be the left anterior descending artery (LAD) in 1,080 (44.9%) of the cases, the right coronary artery (RCA) in 864 (35.9%), the left circumflex artery (LCX) in 334 (13.9%), the saphenous venous graft (SVG) in 29 (1.2%) and the left main artery (LMA) in 15 (0.6%) of the cases. Patients treated for SVG and LM culprit lesions were older (71.7± for SVG, 72.7± for LM versus 60.9± for LAD, 60.6± for RCA and 59.4± for LCX, p<0.01). More SVG patients had renal failure (32.1% versus 7.74% for LAD, 6.1% for RCA, 8.18% for LCX and 6.7% for LMA, P<0.01). Rates of angiographic success were 94.4% for LAD, 96.3% for RCA, 97.6% for LCX, 93.1% for SVG and 86.7% for LMA (p=0.03). Rates of death were higher for the LMA and SVG (13.3% and 6.9%, respectively, vs. a mean of 2.5% at 1 month and 14.3% and 17.2% vs. mean of 7.3% at 2 years,). At 3 years, rates of MACE were highest for SVG (55.6%), followed by LMA (36.4%), LAD (27.2%), RCA (26.7%) and LCX (24.2%).

Conclusion:

Patients treated by PPCI during STEMI have worse outcomes in cases of SVG and LMA as the culprit vessels.