The 67th Annual Conference of the Israel Heart Society

The prognostic impact of multi-vessel coronary artery disease on outcomes of patients suffering from ST-Elevation Myocardial Infarction

Shir Tal 1,2 Leor Perl 1,2 Pablo Codner 1,2 Abed Samara 1,2 Katia Orvin 1,2 Yeela Talmor 1,2 Gabriel Greenberg 1,2 Abid Aassali 1,2 Ran Kornowski 1,2 Hana Vaknin-Assa 1,2
1Cardiology Department, Rabin Medical Center, Israel
2Sackler Faculty of Medicine, Tel Aviv University, Israel

Introduction:

Patients suffering from ST-elevation myocardial infarction (STEMI) are at risk for mortality and major adverse cardiovascular events (MACE) after the acute event.

Patients with multi-vessel disease (MVD) are at high risk for mortality and MACE. Our aim was to assess the impact of MVD on outcomes in patients with STEMI.

Methods:

In this study, based on a prospective registry of all-comers with STEMI, we examined outcomes of 2994 consecutive patients who had presented with STEMI and underwent Primary percutaneous coronary intervention (PPCI) at our medical center, between 2006-2018. Patients were stratified into 3 groups by the extent of their coronary disease as represented by the number of vessels involved – one, two or three vessels. The primary outcomes were mortality and MACE - myocardial infarction, cardiac death, coronary artery bypass surgery (CABG) or target vessel revascularization (TVR) at 1 and 3 years.

Results:

Of 2994 patients with STEMI, 1210 had 1 vessel disease, 1007 had 2 vessel disease and 777 had 3 vessel disease. Mean age was 58.2±12.49, 62.33±12.31, 64.8±12.28 respectively (p<0.001). 80%, 81.7% and 81.3% male (p=0.55). Diabetes mellitus in 22.8%, 25.8% and 35.6% respectively (p<0.001).

Mortality rate at 1 year was 4.9% in single vessel group, 9.6% in two vessel group and 14.5% in three vessel group (p<0.001). Mortality at 3 years was 8%, 14.4% and 20.4%, respectively. MACE at 1 years was 14.2%, 19.1% and 30.9% (p<0.001) and MACE at 3 years was 21.4%, 29.6% and 42.6% respectively (p<0.001). After correcting for confounding factors, the number of vessels involved were associated with significant increased risk for 1-year MACE (OR 1.625, p=0.024) and 3 years MACE (OR 1.470 p=0.012).

Conclusion:

In patients suffering from STEMI, multi-vessel disease is associated with worse outcomes. Further research geared towards mitigating this risk is warranted

.rate of death according to number of vessels involved rate of MACE according to number of vessels involved









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