Impact of multiple complex plaques on short- and long-term clinical outcomes in patients presenting with ST-segment elevation myocardial infarction (from the Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction [HORIZONS-AMI] Trial).
It is not known whether the extent and severity of nonculprit coronary lesions correlate with outcomes in patients with ST-segment elevation myocardial infarction (STEMI) referred for primary percutaneous coronary intervention (PCI). We sought to quantify complex plaques in patients with STEMI referred for primary PCI and to determine their effect on short- and long-term clinical outcomes by examining the core laboratory database for plaque analysis from the Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction study. Baseline demographic, angiographic, and procedural details were compared between patients with single versus multiple complex plaques who underwent single-vessel PCI. Multivariable analysis was performed for predictors of long-term major adverse cardiac events (MACEs), a combined end point of death, reinfarction, ischemic target-vessel revascularization, or stroke, and for death alone. Single-vessel PCI was performed in 3,137 patients (87%): 2,174 (69%) had multiple complex plaques and 963 (31%) had a single complex plaque. Compared with those with a single complex plaque, patients with multiple complex plaques were older (p <0.0001) and had more co-morbidities. The presence of multiple complex plaques was an independent predictor of 3-year MACE (hazard ratio 1.58, 95% confidence interval 1.26 to 1.98, p <0.0001), and death alone (hazard ratio 1.68, 95% confidence interval 1.05 to 2.70, p = 0.03). In conclusion, multiple complex plaques are present in the majority of patients with STEMI who underwent primary PCI, and their presence is an independent predictor of short- and long-term MACE, including death (Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction; NCT00433966).
Division of Cardiology, University of Virginia, Charlottesville, Virginia. Electronic address: keeley@virginia.edu.
Ellen C
EC
Keeley
Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York; Clinical Trials Center, Cardiovascular Research Foundation, New York, New York.
Roxana
R
Mehran
Clinical Trials Center, Cardiovascular Research Foundation, New York, New York; Institute for Cardiology and Cardiac Surgery, New York Methodist Hospital, Brooklyn, New York.
Sorin J
SJ
Brener
Amper Kliniken AG, Dachau, Germany.
Bernhard
B
Witzenbichler
Interventional Cardiology Unit, Ospedali Papa Giovanni XXIII, Bergamo, Italy.
Giulio
G
Guagliumi
Institute of Cardiology, Jagiellonian University, Krakow, Poland.
Dariusz
D
Dudek
Division of Cardiology, Rabin Medical Center, Petach-Tikva, Israel.
Ran
R
Kornowski
Clinical Trials Center, Cardiovascular Research Foundation, New York, New York.
Ovidiu
O
Dressler
Clinical Trials Center, Cardiovascular Research Foundation, New York, New York.
Martin
M
Fahy
Clinical Trials Center, Cardiovascular Research Foundation, New York, New York.
Ke
K
Xu
Cardiovascular Institute, Detroit Medical Center, Detroit, Michigan.
Cindy L
CL
Grines
Division of Cardiology, Columbia University Medical Center, New York, New York; Clinical Trials Center, Cardiovascular Research Foundation, New York, New York.
Gregg W
GW
Stone
D000368:Aged; D017023:Coronary Angiography; D054855:Drug-Eluting Stents; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000209:etiology / Q000601:surgery*; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D058226:Plaque, Atherosclerotic / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D011379:Prognosis; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology