title: Does proximal location of culprit lesion confer worse prognosis in patients undergoing primary percutaneous coronary intervention for ST elevation myocardial infarction?
abstract: ST segment elevation myocardial infarction (STEMI) from proximally located culprit lesion is associated with greater myocardium at jeopardy. In STEMI patients treated with thrombolytics, proximal culprit lesions are known to have worse prognosis. This relation has not been studied in patients undergoing primary percutaneous coronary intervention (PCI). In 3,535 STEMI patients with native coronary artery occlusion pooled from the primary angioplasty in myocardial infarction database, we compared in-hospital and 1-year outcomes between those with proximal (n = 1,606) versus non-proximal (n = 1,929) culprit lesions. Patients with proximal culprits were more likely to die and suffer major adverse cardiovascular events (MACE) during the index hospital stay (3.8% vs 2.2%, P = 0.006; 8.2% vs 5.8%, P = 0.0066, respectively) as well as during 1-year follow-up (6.9% vs 4.5%, P = 0.0013; 22% vs 17%, P = 0.003, respectively) compared to those with non-proximal culprits. After adjustment for baseline differences, proximal culprit was independently predictive of in-hospital death (adjusted odds ratio% 1.58, 95% confidence intervals, CI 1.05-2.40) and MACE (OR 1.41, CI 1.06-1.86), but not 1-year death or MACE. In addition, proximal culprit was independently associated with higher incidence of ventricular arrhythmias and sustained hypotension during the index hospitalization. The univariate impact of proximal culprit lesion on in-hospital death and MACE was comparable to other adverse angiographic characteristics, such as multivessel disease and poor initial thrombolysis in myocardial infarction flow, and greater than that of anterior wall STEMI. In conclusion, proximal location of the culprit lesion is a strong independent predictor of worse in-hospital outcomes in patients with STEMI undergoing primary PCI.
authors.affiliation: Guthrie Clinic, Sayre, Pennsylvania 18840, USA. harjai_kishore@guthrie.org
authors.forename: Kishore J
authors.initials: KJ
authors.lastname: Harjai
authors.forename: Rajendra H
authors.initials: RH
authors.lastname: Mehta
authors.forename: Gregg W
authors.initials: GW
authors.lastname: Stone
authors.forename: Judy A
authors.initials: JA
authors.lastname: Boura
authors.forename: Lorelei
authors.initials: L
authors.lastname: Grines
authors.forename: Bruce R
authors.initials: BR
authors.lastname: Brodie
authors.forename: David A
authors.initials: DA
authors.lastname: Cox
authors.forename: William W
authors.initials: WW
authors.lastname: O'Neill
authors.forename: Cindy L
authors.initials: CL
authors.lastname: Grines
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D015906:Angioplasty, Balloon, Coronary; D015986:Confounding Factors, Epidemiologic; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000473:pathology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006329:Heart Conduction System / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000473:pathology* / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D016896:Treatment Outcome