Long-term outcome in patients with st-elevation myocardial infarction and infarct-related coronary artery ectasia treated with primary percutaneous coronary intervention in Journal of the American College of Cardiology
2012
ASL Città di Torino
Tipo pubblicazione
Conference Abstract
Autori/Collaboratori (11)Vedi tutti...
Sganzerla P
Department of Cardiology, Ospedale di Treviglio, Treviglio, Italy
Indolfi C
Magna Graecia University, Germaneto, Italy
Piscione F
Laboratory of Interventional Cardiology, Federico II University, Naples, Italy
et alii...
Abstract
Background: The clinical outcome of patients presenting coronary artery ectasia and acute myocardial infarction is poorly defined. The aim of this study was to analyze the mid-long term clinical outcome of patients treated by primary angioplasty in whom the culprit lesion was localized in an ectatic vessel. Methods: A systematic review of the databases of eight Italian centers identified 101 patients with coronary artery ectasia who were treated by primary percutaneous coronary intervention (PCI). The end points of the study were the incidence of cardiac death, need of any new revascularization, recurrence of acute myocardial infarction and the combined end point of cardiac death and/or recurrence of acute myocardial infarction during a follow-up mean time of 15.4 months. Cumulative cardiac mortality was evaluated with Kaplan-Meier method. Cox proportional hazard model was used to calculate hazard ratios (HR) and 95% confidence intervals (95% CI) for selected potential predictors of cardiac mortality. Results: The right coronary artery was the principal ectatic vessel involved in acute myocardial infarction (54%), particularly in Type 3 ectasia (p<0.001). Cardiac mortality rate was 5.9% (95% CI: 1.3-10.5) in hospital, 7.1% (95% CI: 3.4-14.3) at 1 year, and 12.8% (95% CI: 6.2-25.7) at 2 years. The most important factors related with cardiac death and survival were: male gender, TIMI 3, single lesion PCI and successful PCI (reduced mortality), age ± 63.5 years, Killip class ± 1, and complicated PCI (increased mortality). (Table presented) Conclusions: Based on our observations, the clinical outcome at mid-long term of patients with coronary artery ectasia treated by primary angioplasty in the setting of acute myocardial infarction seems to be in line with that reported in the Italian epidemiological registries for acute coronary syndromes. No association between different types of ectasia and major adverse cardiac events was found.
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DOI : 10.1016/j.jacc.2012.08.491
Keywords
heart disease; register; gender; male; Kaplan Meier method; systematic review; proportional hazards model; data base; acute coronary syndrome; survival; hospital; right coronary artery; hazard ratio; confidence interval; revascularization; follow up; angioplasty; heart death; mortality; acute heart infarction; patient; therapy; percutaneous coronary intervention; coronary artery ectasia; infarction; ST segment elevation myocardial infarction; human;