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.
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).


CONCLUSIONS
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.
New York Methodist Hospital, Brooklyn, NY, USA. sjb9005@nyp.org
Sorin J
SJ
Brener
Giora
G
Weisz
Akiko
A
Maehara
Roxana
R
Mehran
John
J
McPherson
Naim
N
Farhat
Steven P
SP
Marso
Martin
M
Fahy
Ke
K
Xu
Ecaterina
E
Cristea
Gary S
GS
Mintz
Bernard
B
De Bruyne
Patrick
P
Serruys
Gregg W
GW
Stone
D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy; D000367:Age Factors; D000368:Aged; D000787:Angina Pectoris / Q000209:etiology; D017023:Coronary Angiography / Q000379:methods*; D019160:Endosonography / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000401:mortality; D010359:Patient Readmission; D062645:Percutaneous Coronary Intervention; D016896:Treatment Outcome