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BMC Cardiovascular Disorders

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Open Access 01-12-2024 | ST-Segment Elevation Myocardial Infarction | Research

Impact of residual coronary lesions on outcomes of myocardial infarction patients with multi-vessel disease

Authors: Tarek A. N. Ahmed, Amr A. A. Othman, Salwa R. Demitry, Khaled M. Elmaghraby

Published in: BMC Cardiovascular Disorders | Issue 1/2024

Abstract

Background

The residual burden of coronary artery disease (CAD) after percutaneous coronary intervention (PCI) drew a growing interest. The residual SYNTAX Score (rSS) was a strong prognostic factor of adverse events and all-cause mortality in patients who underwent PCI. In addition, the SYNTAX Revascularization Index (SRI), a derivative of rSS, was used to figure out the treated proportion of CAD and could be used as a prognostic utility in PCI for patients with multi-vessel disease (MVD).

Purpose

We aimed at the assessment of the use of rSS and the SRI as predictors of in-hospital outcomes and up to two-year cumulative follow-up outcomes in patients with MVD who had PCI for the treatment of ST-Elevation Myocardial Infarction (STEMI) or Non-STEMI (NSTEMI).

Methods

We recruited 149 patients who had either STEMI or NSTEMI while having MVD and received treatment with PCI. We divided them into tertiles based on their rSS and SRI values. We calculated baseline SYNTAX Score (bSS) and rSS using the latest version of the calculator on the internet, and we used both scores to calculate SRI. The study end-points were In-hospital composite Major Adverse Cardiovascular Events (MACE) and its components, in-hospital death, and follow-up cumulative MACE up to 2 years.

Results

Neither rSS nor SRI were significant predictors of in-hospital adverse events, while female sex, hypertension, and left ventricular ejection fraction were independent predictors of in-hospital MACE. At the two-year follow-up, Kaplan-Meyer analysis showed a significantly increased incidence of MACE within the third rSS tertile (rSS > 12) compared to other tertiles (log rank p = 0.03). At the same time, there was no significant difference between the three SRI tertiles. Unlike SRI, rSS was a significant predictor of cumulative MACE on univariate Cox regression (HR = 1.037, p < 0.001). On multivariate Cox regression, rSS was a significant independent predictor of two-year cumulative MACE (HR = 1.038, p = 0.0025) along with female sex, hypertension, and left ventricular ejection fraction. We also noted that all patients with complete revascularization survived well throughout the entire follow-up period.

Conclusions

Neither rSS nor SRI could be good predictors of in-hospital MACE, while the rSS was a good predictor of MACE at two-year follow-up. Patients with rSS values > 12 had a significantly higher incidence of cumulative MACE after 2 years. The best prognosis was achieved with complete revascularization.

Lee JH, Park HS, Chae SC, Cho Y, Yang DH, Jeong MH, et al. Predictors of six-month major adverse cardiac events in 30-day survivors after acute myocardial infarction (from the Korea Acute Myocardial Infarction Registry). Am J Cardiol. 2009;104(2):182–9.CrossRefPubMed

Toma M, Buller CE, Westerhout CM, Fu Y, O’Neill WW, Holmes DRJ, et al. Non-culprit coronary artery percutaneous coronary intervention during acute ST-segment elevation myocardial infarction: insights from the APEX-AMI trial. Eur Heart J. 2010;31(14):1701–7.CrossRefPubMed

Boden H, Velders MA, van der Hoeven BL, Cannegieter SC, Schalij MJ. In-hospital major bleeding and its clinical relevance in patients with ST elevation myocardial infarction treated with primary percutaneous coronary intervention. Am J Cardiol. 2013;112(10):1533–9.CrossRefPubMed

Claessen BE, Dangas GD, Weisz G, Witzenbichler B, Guagliumi G, Möckel M, et al. Prognostic impact of a chronic total occlusion in a non-infarct-related artery in patients with ST-segment elevation myocardial infarction: 3-year results from the HORIZONS-AMI trial. Eur Heart J. 2012;33(6):768–75.CrossRefPubMed

Hoebers LP, Vis MM, Claessen BE, van der Schaaf RJ, Kikkert WJ, Baan J, et al. The impact of multi-vessel disease with and without a co-existing chronic total occlusion on short- and long-term mortality in ST-elevation myocardial infarction patients with and without cardiogenic shock. Eur J Heart Fail. 2013;15(4):425–32.CrossRefPubMed

Kastrati A, Banning AP, Koller A, Ahlsson A, Richter DJ, Sibbing D, et al. 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur Heart J. 2018;40(2):87–165. Internet, Available from. https://doi.org/10.1093/eurheartj/ehy394.CrossRef

Mehta SR, Wood DA, Storey RF, Mehran R, Bainey KR, Nguyen H, et al. Complete Revascularization with Multi-vessel PCI for Myocardial Infarction. N Engl J Med. 2019;381(15):1411–21. Internet, Available from:. https://doi.org/10.1056/NEJMoa1907775.CrossRefPubMed

Engstrøm T, Kelbæk H, Helqvist S, Høfsten DE, Kløvgaard L, Holmvang L, et al. Complete revascularisation versus treatment of the culprit lesion only in patients with ST-segment elevation myocardial infarction and multi-vessel disease (DANAMI-3—PRIMULTI): an open-label, randomised controlled trial. Lancet (London, England). 2015;386(9994):665–71.CrossRefPubMed

Wald DS, Morris JK, Wald NJ, Chase AJ, Edwards RJ, Hughes LO, et al. Randomized Trial of Preventive Angioplasty in Myocardial Infarction. N Engl J Med. 2013;369(12):1115–23. Internet, Available from:. https://doi.org/10.1056/NEJMoa1305520.CrossRefPubMed

10.

Gershlick AH, Khan JN, Kelly DJ, Greenwood JP, Sasikaran T, Curzen N, et al. Randomized trial of complete versus lesion-only revascularization in patients undergoing primary percutaneous coronary intervention for STEMI and multi-vessel disease: the CvLPRIT trial. J Am Coll Cardiol. 2015;65(10):963–72.CrossRefPubMedPubMedCentral

11.

Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Socie. Eur Heart J. 2018;39(2):119–77. Internet, Available from. https://doi.org/10.1093/eurheartj/ehx393.CrossRefPubMed

12.

Fox KAA, Clayton TC, Damman P, Pocock SJ, de Winter RJ, Tijssen JGP, et al. Long-term outcome of a routine versus selective invasive strategy in patients with non-ST-segment elevation acute coronary syndrome a meta-analysis of individual patient data. J Am Coll Cardiol. 2010;55(22):2435–45.CrossRefPubMed

13.

Collet J-P, Thiele H, Barbato E, Barthélémy O, Bauersachs J, Bhatt DL, et al. 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: The Task Force for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J. 2021;42(14):1289–367. Internet, Available from. https://doi.org/10.1093/eurheartj/ehaa575.CrossRefPubMed

14.

Généreux P, Palmerini T, Caixeta A, Rosner G, Green P, Dressler O, et al. Quantification and impact of untreated coronary artery disease after percutaneous coronary intervention: The residual SYNTAX (Synergy between PCI with Taxus and Cardiac Surgery) score. J Am Coll Cardiol. 2012;59(24):2165–74.CrossRefPubMedPubMedCentral

15.

Farooq V, Serruys PW, Bourantas CV, Zhang Y, Muramatsu T, Feldman T, et al. Quantification of incomplete revascularization and its association with five-year mortality in the synergy between percutaneous coronary intervention with taxus and cardiac surgery (SYNTAX) trial validation of the residual SYNTAX score. Circulation. 2013;128(2):141–51.CrossRefPubMed

16.

Genereux P, Campos C, Farooq V, Bourantas C, Mohr F, Colombo A, et al. Reasonable Revascularization After Percutaneous Coronary Intervention: Validation of the Syntax Revascularization Index From the Syntax Trial. J Am Coll Cardiol. 2015;65(10):A1698. Internet, Available from:. https://doi.org/10.1016/S0735-1097(15)61698-9.CrossRef

17.

Khan R, Al-Hawwas M, Hatem R, Azzalini L, Fortier A, Joliecoeur EM, et al. Prognostic impact of the residual SYNTAX score on in-hospital outcomes in patients undergoing primary percutaneous coronary intervention. Catheter Cardiovasc Interv. 2016;88(5):740–7. Internet, Available from. https://doi.org/10.1002/ccd.26413.CrossRefPubMed

18.

Roffi M, Patrono C, Collet J-P, Mueller C, Valgimigli M, Andreotti F, et al. 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of. Eur Heart J. 2016;37(3):267–315. Internet, Available from. https://doi.org/10.1093/eurheartj/ehv320.CrossRefPubMed

19.

Sianos G, Morel M, Kappetein A, Morice M-C, Colombo A, Dawkins K, et al. The SYNTAX Score: An angiographic tool grading the complexity of coronary artery disease. EuroIntervention. 2005;1:219–27.PubMed

20.

Généreux P, Campos CAM, Yadav M, Palmerini T, Caixeta AM, Xu K, et al. Reasonable incomplete revascularisation after percutaneous coronary intervention: The SYNTAX Revascularisation Index. EuroIntervention. 2015;11(6):634–42. Internet, Available from: https://eurointervention.pcronline.com/article/reasonable-incomplete-revascularisation-after-percutaneous-coronary-intervention-the-syntax-revascularisation-indexCrossRefPubMed

21.

Stone GW, Bertrand M, Colombo A, Dangas G, Farkouh ME, Feit F, et al. Acute Catheterization and Urgent Intervention Triage strategY (ACUITY) trial: study design and rationale. Am Heart J. 2004;148(5):764–75.CrossRefPubMed

22.

Stacul F, van der Molen AJ, Reimer P, Webb JAW, Thomsen HS, Morcos SK, et al. Contrast induced nephropathy: updated ESUR Contrast Media Safety Committee guidelines. Eur Radiol. 2011;21(12):2527–41.CrossRefPubMed

23.

Ernest S, Eugène M, Pascal V, Ton de V, Ben R, Carlos C, et al. Defining Staged Procedures for Percutaneous Coronary Intervention Trials. JACC Cardiovasc Interv. 2018;11(9):823–32. Internet, Available from:. https://doi.org/10.1016/j.jcin.2018.03.044.CrossRef

24.

Head SJ, Farooq V, Serruys PW, Kappetein AP. The SYNTAX score and its clinical implications. Heart. 2014;100(2):169–77.CrossRefPubMed

25.

Serruys PW, Morice M-C, Kappetein AP, Colombo A, Holmes DR, Mack MJ, et al. Percutaneous Coronary Intervention versus Coronary-Artery Bypass Grafting for Severe Coronary Artery Disease. N Engl J Med. 2009;360(10):961–72. Internet, Available from. https://doi.org/10.1056/NEJMoa0804626.CrossRefPubMed

26.

Généreux P, Campos CM, Farooq V, Bourantas CV, Mohr FW, Colombo A, et al. Validation of the SYNTAX Revascularization Index to Quantify Reasonable Level of Incomplete Revascularization After Percutaneous Coronary Intervention. Am J Cardiol. 2015;116(2):174–86.CrossRefPubMed

27.

Altekin RE, Kilinc AY, Onac M, Cicekcibasi O. Prognostic Value of the Residual SYNTAX Score on In-Hospital and Follow-Up Clinical Outcomes in ST Elevation Myocardial Infarction Patients Undergoing Percutaneous Coronary Interventions. Chen R, editor. Cardiol Res Pract. 2020;2020:9245431. Internet, Available from. https://doi.org/10.1155/2020/9245431.CrossRefPubMedPubMedCentral

28.

Loutfi M, Ayad S, Sobhy M. Impact of the residual SYNTAX score on outcomes of revascularization in patients with ST-segment elevation myocardial infarction and multi-vessel disease. Clin Med Insights Cardiol. 2016;10:29–35. Internet, Available from:. https://doi.org/10.4137/CMC.S35730.CrossRefPubMedPubMedCentral

29.

Valgimigli M, Bueno H, Byrne RA, Collet J-P, Costa F, Jeppsson A, et al. 2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS: The Task Force for dual antiplatelet therapy in coronary artery disease of the European Society of Cardiology (ESC) and of the European. Eur Heart J. 2018;39(3):213–60. Internet, Available from. https://doi.org/10.1093/eurheartj/ehx419.CrossRefPubMed

30.

Zhong P-Y, Shang Y-S, Bai N, Ma Y, Niu Y, Wang Z-L. Efficacy and Safety of Very Short-Term Dual Antiplatelet Therapy After Drug-Eluting Stents Implantation for Acute Coronary Syndrome: A Systematic Review and Meta-Analysis of Randomized Clinical Trials. Front Cardiovasc Med. 2021;8 Internet, Available from: https://www.frontiersin.org/articles/10.3389/fcvm.2021.660360

31.

Gragnano F, Mehran R, Branca M, Franzone A, Baber U, Jang Y, et al. P2Y(12) Inhibitor Monotherapy or Dual Antiplatelet Therapy After Complex Percutaneous Coronary Interventions. J Am Coll Cardiol. 2023;81(6):537–52.CrossRefPubMed

32.

Obayashi Y, Watanabe H, Morimoto T, Yamamoto K, Natsuaki M, Domei T, et al. Clopidogrel Monotherapy After 1-Month Dual Antiplatelet Therapy in Percutaneous Coronary Intervention: From the STOPDAPT-2 Total Cohort. Circ Cardiovasc Interv. 2022;15(8):e012004. Internet, Available from:. https://doi.org/10.1161/CIRCINTERVENTIONS.122.012004.CrossRefPubMedPubMedCentral

33.

Feng W-H, Chang Y-C, Lin Y-H, Chen H-L, Chen C-Y, Lin T-H, et al. P2Y12 Inhibitor Monotherapy versus Conventional Dual Antiplatelet Therapy in Patients with Acute Coronary Syndrome after Percutaneous Coronary Intervention: A Meta-Analysis. Pharmaceuticals (Basel). 2023;16(2):232.CrossRefPubMedPubMedCentral

34.

Kwok CS, Rao SV, Myint PK, Keavney B, Nolan J, Ludman PF, et al. Major bleeding after percutaneous coronary intervention and risk of subsequent mortality: a systematic review and meta-analysis. Open Hear. 2014;1(1):e000021. Internet, Available from:. http://openheart.bmj.com/content/1/1/e000021.abstractCrossRef

Title: Impact of residual coronary lesions on outcomes of myocardial infarction patients with multi-vessel disease
Authors: Tarek A. N. Ahmed
Amr A. A. Othman
Salwa R. Demitry
Khaled M. Elmaghraby
Publication date: 01-12-2024
Publisher: BioMed Central
Keywords: ST-Segment Elevation Myocardial Infarction
Myocardial Infarction
Arterial Diseases
Published in: BMC Cardiovascular Disorders / Issue 1/2024
Electronic ISSN: 1471-2261
DOI: https://doi.org/10.1186/s12872-023-03657-2

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Impact of residual coronary lesions on outcomes of myocardial infarction patients with multi-vessel disease

Abstract

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Methods

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Conclusions

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