Does clinical presentation affect outcome among patients with acute coronary syndromes undergoing percutaneous coronary intervention? Insights from the Providing Regional Observations to Study Predictors of Events in the Coronary Tree study

Sorin J. Brener, Giora Weisz, Akiko Maehara, Roxana Mehran, John McPherson, Naim Farhat, Steven P. Marso, Martin Fahy, Ke Xu, Ecaterina Cristea, Gary S. Mintz, Bernard De Bruyne, Patrick Serruys, Gregg W. Stone

Research output: Contribution to journalArticle

2 Scopus citations

Abstract

Background: In some prior studies, patients with ST-elevation myocardial infarction (STEMI) as compared with patients with non-STEMI (NSTEMI) tended to have a higher early mortality but similar long-term outcomes. We compared the angiographic and intravascular ultrasound (IVUS) characteristics of patients with STEMI and NSTEMI in the PROSPECT study to evaluate the independent prognostic value of clinical presentation on long-term outcome. Methods: After successful revascularization, patients had 3-vessel quantitative coronary angiography, gray scale, and radiofrequency intravascular ultrasound (IVUS) imaging. The primary end point was the occurrence of major adverse cardiac events (MACE) (cardiac death, myocardial infarction, or rehospitalization for unstable or progressive angina). Results: There were 211 patients (31.6%) with STEMI and 457 (68.4%) with NSTEMI. Patients with STEMI and NSTEMI had similar angiographic and IVUS morphologic characteristics. At 3 years, MACE occurred in 22.1% and 19.6%, respectively (hazard ratio [HR] 1.16 [0.81, 1.68], P =.42). There was a higher overall mortality (HR 2.16 [0.94, 4.99], P =.06) and a significantly higher incidence of probable stent thrombosis (HR 4.34 [1.09, 17.36], P =.02) in the STEMI cohort. There were no significant differences between the 2 groups with respect to events related to culprit or to nonculprit lesions. ST-elevation myocardial infarction presentation was not an independent predictor of 3-year MACE (HR 1.14 [0.77, 1.67], P =.52). Conclusion: Patients with STEMI and NSTEMI did not differ with respect to residual nonculprit lesion angiographic or IVUS characteristics and had similar rates of MACE at 3 years, without late catch-up in NSTEMI. However, probable stent thrombosis and mortality were higher in the STEMI cohort.

Original languageEnglish (US)
Pages (from-to)561-567
Number of pages7
JournalAmerican Heart Journal
Volume164
Issue number4
DOIs
StatePublished - Oct 1 2012

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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