title: Impact of Non-Infarct-Related Artery Disease on Infarct Size and Outcomes (from the CRISP-AMI Trial).
abstract: BACKGROUND
  Non-infarct-related artery (non-IRA) disease is prevalent in patients with ST-segment elevation myocardial infarction (STEMI). We aimed to assess the impact of non-IRA disease on infarct size and clinical outcomes in patients with acute STEMI.
  
  
  METHODS
  The Counterpulsation to Reduce Infarct Size Pre-PCI Acute Myocardial Infarction (CRISP-AMI) trial randomized patients to intra-aortic balloon counterpulsation (IABC) vs no IABC prior to percutaneous coronary intervention in patients with acute STEMI. Infarct size (% left ventricular mass) at 3-5 days post percutaneous coronary intervention and 6-month clinical outcomes were compared between patients with and without non-IRA disease (defined as ≥50% stenosis in at least one non-IRA).
  
  
  RESULTS
  A total of 324 (96.1%) patients had anterior STEMI, of whom 34.9% had non-IRA disease. There was no difference in infarct size (% left ventricular mass) between patients with and without non-IRA disease (median 39% vs 39%; P = .73). At 6 months, there was no difference in rates of recurrent myocardial infarction (0.9% vs 0.9%; P = .78), major Thrombolysis In Myocardial Infarction bleeding (0.9% vs 0.5%; P = .77), or all-cause death (3.5% vs 2.4%; P = .61) in patients with and without non-IRA disease, respectively. Patients with non-IRA disease had a higher rate of new/worsening heart failure with hospitalization (8.8% vs 1.9%; P = .0050).
  
  
  CONCLUSIONS
  More than one-third of patients with anterior STEMI in the CRISP-AMI study had non-IRA disease. These patients had similar infarct sizes and rates of recurrent myocardial infarction, major bleeding, and all-cause death. Patients with non-IRA disease did have a higher rate of new/worsening heart failure with hospitalization. Further study is needed to understand the mechanisms of outcomes of patients with non-IRA disease.
authors.affiliation: Duke Clinical Research Institute, Durham, NC.
authors.forename: Rohan
authors.initials: R
authors.lastname: Shah
authors.affiliation: Duke Clinical Research Institute, Durham, NC.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Clare
authors.affiliation: Duke Clinical Research Institute, Durham, NC.
authors.forename: Karen
authors.initials: K
authors.lastname: Chiswell
authors.affiliation: Duke Clinical Research Institute, Durham, NC; Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC.
authors.forename: W Schuyler
authors.initials: WS
authors.lastname: Jones
authors.affiliation: Department of Cardiovascular Sciences, Citizens Hospitals, Hyderabad, India.
authors.forename: A Sreenivas
authors.initials: AS
authors.lastname: Kumar
authors.affiliation: Medical Clinic II, University Heart Center Lübeck, Germany.
authors.forename: Holger
authors.initials: H
authors.lastname: Thiele
authors.affiliation: Division of Cardiology, Memorial Hermann Heart and Vascular Institute, University of Texas, Houston.
authors.forename: Richard W
authors.initials: RW
authors.lastname: Smalling
authors.affiliation: Division of Cardiology, Medanta - the Medicity, Haryana, India.
authors.forename: Praveen
authors.initials: P
authors.lastname: Chandra
authors.affiliation: Division of Cardiology, Newark Beth Israel Medical Center, NJ.
authors.forename: Marc
authors.initials: M
authors.lastname: Cohen
authors.affiliation: Cardiovascular Division, King's College, London, England.
authors.forename: Divaka
authors.initials: D
authors.lastname: Perera
authors.affiliation: Department of Cardiovascular Medicine, Flinders Medical Center, Bedford Park, Australia.
authors.forename: Derek P
authors.initials: DP
authors.lastname: Chew
authors.affiliation: Department of Cardiology, Liverpool Hospital, Australia.
authors.forename: John K
authors.initials: JK
authors.lastname: French
authors.affiliation: Department of Cardiology, Leeds General Infirmary, England.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Blaxill
authors.affiliation: Duke Clinical Research Institute, Durham, NC; Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC.
authors.forename: E Magnus
authors.initials: EM
authors.lastname: Ohman
authors.affiliation: Duke Clinical Research Institute, Durham, NC; Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC. Electronic address: manesh.patel@duke.edu.
authors.forename: Manesh R
authors.initials: MR
authors.lastname: Patel
mesh_terms: D015897:Comorbidity; D003324:Coronary Artery Disease / Q000453:epidemiology* / Q000473:pathology; D023921:Coronary Stenosis / Q000453:epidemiology* / Q000473:pathology; D005260:Female; D006333:Heart Failure / Q000453:epidemiology*; D006801:Humans; D007423:Intra-Aortic Balloon Pumping / Q000379:methods / Q000706:statistics & numerical data*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D062645:Percutaneous Coronary Intervention / Q000379:methods / Q000706:statistics & numerical data*; D015995:Prevalence; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D000072657:ST Elevation Myocardial Infarction / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000473:pathology / Q000628:therapy; D016896:Treatment Outcome; D020257:Ventricular Remodeling
keywords: Heart failure; Infarct-related artery; Non-infarct-related artery; ST-segment elevation myocardial infarction