Patent coronary artery and myocardial infarction in the era of primary angioplasty: assessment of an old problem in a new setting with data from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR).
OBJECTIVE
The purpose of this study was to evaluate factors that contribute to a patent IRA (infarct - related artery) and the prognostic impact of a patent IRA in patients with ST-elevation myocardial infarction.


RESULTS
Using the Swedish angiography and angioplasty registry (SCAAR) we included all patients with STEMI and one-vessel coronary artery disease who underwent primary PCI of the culprit lesion only from May 2005 to December 2007. A patent IRA was found in 1,104 of 3,284 patients. Patients with an occluded IRA had significantly increased 7-day mortality (HR, 3.03, 95% CI 1.68-5.46, P<0.001). The incidence of an occluded IRA increased with higher age, in patients over 80 years of age (OR, 1.23, 95% CI; 0.92-1.64), lower in patients on lipid-lowering drugs (OR, 0.68, 95% CI; 0.54-0.86) and lower in patients pre-treated with heparin (OR 0.71, 95% CI; 0.60-0.83) or GPIIb/IIIa receptor blockade (OR 0.77, 95% CI; 0.61-0.97). Treatment with acetylsalicylic acid or clopidogrel had no effect on IRA patency.


CONCLUSIONS
IRA patency was associated with a lower 7-day mortality. Older STEMI patients and patients not taking lipid-lowering drugs or pre-treated with heparin or GPIIb/IIIa receptor blockers seem to constitute risk groups for having an occluded IRA.
Department of Cardiology, Örebro University Hospital, Örebro, Sweden. Martin.Kreutzer@orebroll.se
Martin
M
Kreutzer
Anders
A
Magnuson
Bo
B
Lagerqvist
Ole
O
Fröbert
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary; D017023:Coronary Angiography; D054059:Coronary Occlusion / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy*; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors; D012042:Registries; D014654:Vascular Patency
D019039:Platelet Glycoprotein GPIIb-IIIa Complex