Long-term prognostic impact of the left anterior descending coronary artery as the STEMI-related culprit vessel: subanalysis of the EXAMINATION-EXTEND trial

Introduction and objectives: There is limited data on the impact of the culprit vessel on very long-term outcomes after ST-elevation myocardial infarction (STEMI). The aim was to analyze the impact of the left anterior descending coronary artery (LAD) as the culprit vessel of STEMI on very long-term...

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Detalles Bibliográficos
Autores: Vidal-Calés, P, Bujak, K, Rinaldi, R, Salazar-Rodríguez, A, Ortega-Paz, L, Gómez-Lara, J, Jiménez-Díaz, V, Jiménez, M, Jiménez-Quevedo, P, Diletti, R, Bordes, P, Campo, G, Silvestro, A, Maristany, J, Flores, X, De Miguel-Castro, A, Iñiguez, A, Ielasi, A, Tespili, M, Lenzen, M, Gonzalo, N, Tebaldi, M, Biscaglia, S, Romaguera, R, Gómez-Hospital, JA, Serruys, PW, Sabaté, M, Brugaletta, S
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2024
País:España
Institución:Instituto de Investigación Biomédica y Sanitaria de Alicante (ISABIAL)
Repositorio:r-ISABIAL. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica y Sanitaria de Alicante
OAI Identifier:oai:isabial.fundanetsuite.com:p11016
Acceso en línea:https://isabial.portalinvestigacion.com/publicaciones11016
https://recintervcardiol.org/images/pdf-files/RECIC_24_060_AO_Brugaletta_UK_13_12.pdf
Access Level:acceso abierto
Palabra clave:Acute myocardial infarction
STEMI
Angiography
Coronary
Percutaneous coronary intervention
Descripción
Sumario:Introduction and objectives: There is limited data on the impact of the culprit vessel on very long-term outcomes after ST-elevation myocardial infarction (STEMI). The aim was to analyze the impact of the left anterior descending coronary artery (LAD) as the culprit vessel of STEMI on very long-term outcomes. Methods: We analyzed patients included in the EXAMINATION-EXTEND study (NCT04462315) treated with everolimus-eluting stents or bare-metal stents after STEMI (1498 patients) and stratified according to the culprit vessel (LAD vs other vessels). The primary endpoint was the patient-oriented composite endpoint (POCE), including all-cause mortality, myocardial infarction (MI) or revascularization at 10 years. Secondary endpoints were individual components of POCE, device-oriented composite endpoint and its individual components and stent thrombosis. We performed landmark analyses at 1 and 5 years. All endpoints were adjusted with multivariable Cox regression models. Results: The LAD was the culprit vessel in 631 (42%) out of 1498 patients. The LAD-STEMI group had more smokers, advanced Killip class and worse left ventricular ejection fraction. Conversely, non-LAD-STEMI group showed more peripheral vascular disease, previous MI, or previous PCI. At 10 years, no differences were observed between groups regarding POCE (34.9% vs 35.4%; adjusted hazard ratio [HR], 0.95; 95% confidence interval [95%CI], 0.79-1.13; P = . 56) or other endpoints. The all-cause mortality rate was higher in the LAD-STEMI group ( P = . 041) at 1-year. Conclusions: In a contemporary cohort of STEMI patients, there were no differences in POCE between LAD as the STEMI-related culprit vessel and other vessels at 10 years follow-up. However, all-cause mortality was more common in the LAD-STEMI group within the first year after STEMI.

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