title: Comparison of effectiveness of primary angioplasty for proximal versus distal right coronary artery culprit lesion during acute myocardial infarction.
abstract: From the cohort of 4,023 patients enrolled in the Primary Angioplasty for Myocardial Infarction (PAMI) trials, we pooled clinical, angiographic, and outcomes data on 1,521 patients with culprit lesions in the right coronary artery (RCA). We compared angiographic results, procedural complications, and in-hospital and 1-year clinical outcomes between patients with proximal RCA (n = 572) versus nonproximal RCA culprit lesions (n = 949). Patients with proximal RCA culprit lesions were older, had lower systolic blood pressure, greater diameter stenosis, and were less likely to have Thrombolysis In Myocardial Infarction (TIMI) 2 or 3 flow (19% vs 31%; p <0.0001) before percutaneous coronary intervention (PCI). After PCI, the incidence of TIMI 3 flow (94% vs 93%) was similar between groups. Patients with proximal RCA lesions were more likely to have bradyarrhythmias (30% vs 23%, p = 0.016) and require an intra-aortic balloon pump (IABP; 4.6% vs 2%, p = 0.034) during PCI. In-hospital complications, including mortality (2.3% vs 2.2%) and reinfarction (1.4% vs 1.1%), and the 1-year incidence of death, reinfarction, ischemia driven target vessel revascularization, and major adverse cardiovascular events were similar between groups. After adjustment for baseline differences, proximal RCA location of the culprit lesion was independently associated with greater IABP use (odds ratio 2.41, 95% confidence interval 1.04 to 5.58) but not with bradyarrhythmias during PCI. Thus, in patients with acute myocardial infarction referred for primary angioplasty, proximal RCA location of the culprit lesion is associated with excellent clinical outcomes that are similar to nonproximal RCA lesions.
authors.affiliation: William Beaumont Hospital, Royal Oak, Michigan 48073, USA.
authors.forename: Kishore J
authors.initials: KJ
authors.lastname: Harjai
authors.forename: Judy
authors.initials: J
authors.lastname: Boura
authors.forename: Lorelei
authors.initials: L
authors.lastname: Grines
authors.forename: James
authors.initials: J
authors.lastname: Goldstein
authors.forename: Gregg W
authors.initials: GW
authors.lastname: Stone
authors.forename: Bruce
authors.initials: B
authors.lastname: Brodie
authors.forename: David
authors.initials: D
authors.lastname: Cox
authors.forename: William W
authors.initials: WW
authors.lastname: O'Neill
authors.forename: Cindy
authors.initials: C
authors.lastname: Grines
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects; D001919:Bradycardia / Q000209:etiology; D002986:Clinical Trials as Topic; D003326:Coronary Circulation / Q000502:physiology; D023921:Coronary Stenosis / Q000150:complications*; D003331:Coronary Vessels / Q000473:pathology*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007022:Hypotension / Q000209:etiology; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D012307:Risk Factors; D016896:Treatment Outcome