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 Citations (Scopus)

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 2012

Fingerprint

Percutaneous Coronary Intervention
Acute Coronary Syndrome
Stents
Mortality
Thrombosis
Coronary Angiography
Ultrasonography
Myocardial Infarction
ST Elevation Myocardial Infarction
Non-ST Elevated Myocardial Infarction
Incidence

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

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

In: American Heart Journal, Vol. 164, No. 4, 10.2012, p. 561-567.

Research output: Contribution to journalArticle

Brener, Sorin J. ; Weisz, Giora ; Maehara, Akiko ; Mehran, Roxana ; McPherson, John ; Farhat, Naim ; Marso, Steven P. ; Fahy, Martin ; Xu, Ke ; Cristea, Ecaterina ; Mintz, Gary S. ; De Bruyne, Bernard ; Serruys, Patrick ; Stone, Gregg W. / 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. In: American Heart Journal. 2012 ; Vol. 164, No. 4. pp. 561-567.
@article{9b60d83f2705431b84f05019d9751957,
title = "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",
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.",
author = "Brener, {Sorin J.} and Giora Weisz and Akiko Maehara and Roxana Mehran and John McPherson and Naim Farhat and Marso, {Steven P.} and Martin Fahy and Ke Xu and Ecaterina Cristea and Mintz, {Gary S.} and {De Bruyne}, Bernard and Patrick Serruys and Stone, {Gregg W.}",
year = "2012",
month = "10",
doi = "10.1016/j.ahj.2012.07.025",
language = "English (US)",
volume = "164",
pages = "561--567",
journal = "American Heart Journal",
issn = "0002-8703",
publisher = "Mosby Inc.",
number = "4",

}

TY - JOUR

T1 - 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

AU - Brener, Sorin J.

AU - Weisz, Giora

AU - Maehara, Akiko

AU - Mehran, Roxana

AU - McPherson, John

AU - Farhat, Naim

AU - Marso, Steven P.

AU - Fahy, Martin

AU - Xu, Ke

AU - Cristea, Ecaterina

AU - Mintz, Gary S.

AU - De Bruyne, Bernard

AU - Serruys, Patrick

AU - Stone, Gregg W.

PY - 2012/10

Y1 - 2012/10

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=84867577518&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84867577518&partnerID=8YFLogxK

U2 - 10.1016/j.ahj.2012.07.025

DO - 10.1016/j.ahj.2012.07.025

M3 - Article

C2 - 23067915

AN - SCOPUS:84867577518

VL - 164

SP - 561

EP - 567

JO - American Heart Journal

JF - American Heart Journal

SN - 0002-8703

IS - 4

ER -