PMID- 28216061 OWN - NLM STAT- MEDLINE DCOM- 20180503 LR - 20180618 IS - 1444-2892 (Electronic) IS - 1443-9506 (Linking) VI - 26 IP - 10 DP - 2017 Oct TI - Outcomes After Primary Percutaneous Coronary Intervention for ST-Elevation Myocardial Infarction Caused by Ectatic Infarct Related Arteries. PG - 1059-1068 LID - S1443-9506(17)30026-4 [pii] LID - 10.1016/j.hlc.2016.12.006 [doi] AB - BACKGROUND: There is minimal published data on outcomes of patients presenting with ST elevation myocardial infarction (STEMI) due to an ectatic infarct-related artery (EIRA). The aim of this study was to analyse the clinical characteristics and outcomes of these patients presenting for primary percutaneous coronary intervention (P-PCI) in comparison with non-EIRA. METHODS: Of the 1834 patients who presented at our institution for P-PCI between February 2008 and November 2013, 25 (1.4%) were identified as having an EIRA. These patients were compared with those with non-EIRA (80 patients) who were age, gender and lesion matched. Further sub-group analysis on in-hospital and long-term outcomes was done comparing EIRA stented and non-stented patients. Clinical events evaluated include death, recurrent infarction, unstable angina, or target lesion revascularisation (TLR). RESULTS: Baseline characteristics were similar between patients with EIRA and non-EIRA although none of those with EIRA had diabetes mellitus. By comparison to the non-EIRA group, the major procedural differences for patients with EIRA were (1) a greater incidence of large thrombus burden (96.0% vs 22.5%, p=0.0001), (2) increased usage of peri-procedural glycoprotein IIb/IIIa inhibitors (72.0% vs 37.5%, p=0.01) and post-procedural anticoagulation (28.0% vs 5.0%, p=0.004), (3) larger mean stent dimension (3.9+/-0.8mm vs 3.4+/-0.6mm, p=0.04) and (4) a higher percentage of P-PCI cases that did not have stent deployment (44.0% vs 7.5%, p=0.0001). Patients with STEMI from EIRA had similar in-hospital outcomes but a higher long-term incidence of composite cardiovascular events at mean follow-up of 36.6+/-14.1months (44.0% vs 16.3% for non-EIRA, p=0.01). Although patients with EIRA who received stenting had better in-hospital outcomes than the non-stented cohort (composite cardiovascular event rate: 0.0% vs 36.4%, p=0.03), long-term outcomes were comparable (35.7% vs 54.6%, p=0.59) due to a relatively high frequency of non-fatal MI and unstable angina in both groups. CONCLUSION: Patients with STEMI due to EIRA carry worse long-term outcomes than those with non-EIRA. While successful stent deployment in the setting of EIRA improves procedural and inpatient success rates, it does not necessarily convey benefit to long-term event rates due to recurrent acute coronary syndromes. CI - Copyright (c) 2017 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved. FAU - Bogana Shanmugam, Vimalraj AU - Bogana Shanmugam V AD - Monash Cardiovascular Research Centre, Monash University, Melbourne, Vic, Australia. Electronic address: vimalcardio@yahoo.com. FAU - Psaltis, Peter J AU - Psaltis PJ AD - Vascular Research Centre, Heart Health Theme, South Australian Health and Medical Research Institute, Adelaide & School of Medicine, University of Adelaide, Adelaide, SA, Australia. FAU - T L Wong, Dennis AU - T L Wong D AD - Monash Cardiovascular Research Centre, Monash University, Melbourne, Vic, Australia. FAU - T Meredith, Ian AU - T Meredith I AD - Monash Cardiovascular Research Centre, Monash University, Melbourne, Vic, Australia. FAU - Malaiapan, Yuvaraj AU - Malaiapan Y AD - Monash Cardiovascular Research Centre, Monash University, Melbourne, Vic, Australia. FAU - Ahmar, Wally AU - Ahmar W AD - Monash Cardiovascular Research Centre, Monash University, Melbourne, Vic, Australia. LA - eng PT - Comparative Study PT - Journal Article DEP - 20170207 PL - Australia TA - Heart Lung Circ JT - Heart, lung & circulation JID - 100963739 SB - IM MH - Coronary Angiography MH - Coronary Vessel Anomalies/*complications/diagnosis/surgery MH - Coronary Vessels/*diagnostic imaging/surgery MH - Drug-Eluting Stents MH - Electrocardiography MH - Female MH - Follow-Up Studies MH - Humans MH - Male MH - Middle Aged MH - Percutaneous Coronary Intervention/*methods MH - Postoperative Period MH - Retrospective Studies MH - ST Elevation Myocardial Infarction/diagnosis/etiology/*surgery MH - Time Factors MH - Treatment Outcome OTO - NOTNLM OT - Coronary aneurysm OT - Coronary artery ectasia OT - Ectatic infarct related artery OT - Large thrombus burden OT - Primary percutaneous coronary intervention OT - ST-elevation myocardial infarction EDAT- 2017/02/22 06:00 MHDA- 2018/05/04 06:00 CRDT- 2017/02/21 06:00 PHST- 2016/05/19 00:00 [received] PHST- 2016/11/28 00:00 [revised] PHST- 2016/12/10 00:00 [accepted] PHST- 2017/02/22 06:00 [pubmed] PHST- 2018/05/04 06:00 [medline] PHST- 2017/02/21 06:00 [entrez] AID - S1443-9506(17)30026-4 [pii] AID - 10.1016/j.hlc.2016.12.006 [doi] PST - ppublish SO - Heart Lung Circ. 2017 Oct;26(10):1059-1068. doi: 10.1016/j.hlc.2016.12.006. Epub 2017 Feb 7.