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Culprit vessel: impact on short-term and long-term prognosis in patients with ST-elevation myocardial infarction

Open heart, 2018, Vol.5 (2), p.e000852-e000852 [Peer Reviewed Journal]

Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. ;2018 Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License. ;Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. 2018 ;ISSN: 2053-3624 ;ISSN: 2398-595X ;EISSN: 2053-3624 ;DOI: 10.1136/openhrt-2018-000852 ;PMID: 30228908

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  • Title:
    Culprit vessel: impact on short-term and long-term prognosis in patients with ST-elevation myocardial infarction
  • Author: Entezarjou, Artin ; Mohammad, Moman Aladdin ; Andell, Pontus ; Koul, Sasha
  • Subjects: Angioplasty ; Blood clots ; Cardiac and Cardiovascular Systems ; Cardiovascular disease ; Clinical Medicine ; Coronary Artery Disease ; Coronary vessels ; Electrocardiography ; Heart attacks ; Heart failure ; Heart surgery ; Hospitals ; Kardiologi ; Klinisk medicin ; Medical and Health Sciences ; Medical imaging ; Medicin och hälsovetenskap ; Mortality ; Patients ; Population ; Stents ; Veins & arteries
  • Is Part Of: Open heart, 2018, Vol.5 (2), p.e000852-e000852
  • Description: BackgroundST-elevation myocardial infarction (STEMI) occurs as a result of rupture of an atherosclerotic plaque in the coronary arteries. Limited data exist regarding the impact of culprit coronary vessel on hard clinical event rates. This study investigated the impact of culprit vessel on outcomes after primary percutaneous coronary intervention (PCI) of STEMI.MethodsA total of 29 832 previously cardiac healthy patients who underwent primary PCI between 2003 and 2014 were prospectively included from the Swedish Coronary Angiography and Angioplasty Registry and the Registry of Information and Knowledge about Swedish Heart Intensive care Admissions. Patients were stratified into three groups based on culprit vessel (right coronary artery (RCA), left anterior descending artery (LAD) and left circumflex artery (LCx)). The primary outcome was 1-year mortality. The secondary outcomes included 30-day and 5-year mortality, as well as heart failure, stroke, bleeding and myocardial reinfarction at 30 days, 1 year and 5 years. Univariable and multivariable analyses were done using Cox regression models.ResultsOne-year analyses revealed that LAD infarctions had the highest increased risk of death, heart failure and stroke compared with RCA infarctions, which had the lowest risk. Sensitivity analyses revealed that reduced left ventricular ejection fraction on discharge partially explained this increased relative risk in mortality. Furthermore, landmark analyses revealed that culprit vessel had no significant influence on 1-year mortality if a patient survived 30 days after myocardial infarction. Subgroup analyses revealed female sex and multivessel disease (MVD) as significant high-risk groups with respect to 1-year mortality.ConclusionsLAD and LCx infarctions had a relatively higher adjusted mortality rate compared with RCA infarctions, with LAD infarctions in particular being associated with an increased risk of heart failure, stroke and death. Culprit vessel had limited influence on mortality after 1 month. High-risk patient groups include LAD infarctions in women or with concomitant MVD.
  • Publisher: England: BMJ Publishing Group LTD
  • Language: English;Swedish
  • Identifier: ISSN: 2053-3624
    ISSN: 2398-595X
    EISSN: 2053-3624
    DOI: 10.1136/openhrt-2018-000852
    PMID: 30228908
  • Source: BMJ Open Access Journals
    Open Access: PubMed Central
    Open Access: Freely Accessible Journals by multiple vendors
    Alma/SFX Local Collection
    SWEPUB Freely available online
    ROAD: Directory of Open Access Scholarly Resources
    ProQuest Central
    DOAJ Directory of Open Access Journals
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