title: Outcomes After Primary Percutaneous Coronary Intervention for ST-Elevation Myocardial Infarction Caused by Ectatic Infarct Related Arteries.
abstract: BACKGROUND
  There is minimal published data on outcomes of patients presenting with ST elevation myocardial infarction (STEMI) due to an ectatic infarct-related artery (EIRA). The aim of this study was to analyse the clinical characteristics and outcomes of these patients presenting for primary percutaneous coronary intervention (P-PCI) in comparison with non-EIRA.
  
  
  METHODS
  Of the 1834 patients who presented at our institution for P-PCI between February 2008 and November 2013, 25 (1.4%) were identified as having an EIRA. These patients were compared with those with non-EIRA (80 patients) who were age, gender and lesion matched. Further sub-group analysis on in-hospital and long-term outcomes was done comparing EIRA stented and non-stented patients. Clinical events evaluated include death, recurrent infarction, unstable angina, or target lesion revascularisation (TLR).
  
  
  RESULTS
  Baseline characteristics were similar between patients with EIRA and non-EIRA although none of those with EIRA had diabetes mellitus. By comparison to the non-EIRA group, the major procedural differences for patients with EIRA were (1) a greater incidence of large thrombus burden (96.0% vs 22.5%, p=0.0001), (2) increased usage of peri-procedural glycoprotein IIb/IIIa inhibitors (72.0% vs 37.5%, p=0.01) and post-procedural anticoagulation (28.0% vs 5.0%, p=0.004), (3) larger mean stent dimension (3.9±0.8mm vs 3.4±0.6mm, p=0.04) and (4) a higher percentage of P-PCI cases that did not have stent deployment (44.0% vs 7.5%, p=0.0001). Patients with STEMI from EIRA had similar in-hospital outcomes but a higher long-term incidence of composite cardiovascular events at mean follow-up of 36.6±14.1months (44.0% vs 16.3% for non-EIRA, p=0.01). Although patients with EIRA who received stenting had better in-hospital outcomes than the non-stented cohort (composite cardiovascular event rate: 0.0% vs 36.4%, p=0.03), long-term outcomes were comparable (35.7% vs 54.6%, p=0.59) due to a relatively high frequency of non-fatal MI and unstable angina in both groups.
  
  
  CONCLUSIONS
  Patients with STEMI due to EIRA carry worse long-term outcomes than those with non-EIRA. While successful stent deployment in the setting of EIRA improves procedural and inpatient success rates, it does not necessarily convey benefit to long-term event rates due to recurrent acute coronary syndromes.
authors.affiliation: Monash Cardiovascular Research Centre, Monash University, Melbourne, Vic, Australia. Electronic address: vimalcardio@yahoo.com.
authors.forename: Vimalraj
authors.initials: V
authors.lastname: Bogana Shanmugam
authors.affiliation: Vascular Research Centre, Heart Health Theme, South Australian Health and Medical Research Institute, Adelaide & School of Medicine, University of Adelaide, Adelaide, SA, Australia.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Psaltis
authors.affiliation: Monash Cardiovascular Research Centre, Monash University, Melbourne, Vic, Australia.
authors.forename: Dennis
authors.initials: D
authors.lastname: T L Wong
authors.affiliation: Monash Cardiovascular Research Centre, Monash University, Melbourne, Vic, Australia.
authors.forename: Ian
authors.initials: I
authors.lastname: T Meredith
authors.affiliation: Monash Cardiovascular Research Centre, Monash University, Melbourne, Vic, Australia.
authors.forename: Yuvaraj
authors.initials: Y
authors.lastname: Malaiapan
authors.affiliation: Monash Cardiovascular Research Centre, Monash University, Melbourne, Vic, Australia.
authors.forename: Wally
authors.initials: W
authors.lastname: Ahmar
mesh_terms: D017023:Coronary Angiography; D003330:Coronary Vessel Anomalies / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D003331:Coronary Vessels / Q000000981:diagnostic imaging* / Q000601:surgery; D054855:Drug-Eluting Stents; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D011184:Postoperative Period; D012189:Retrospective Studies; D000072657:ST Elevation Myocardial Infarction / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome
keywords: Coronary aneurysm; Coronary artery ectasia; Ectatic infarct related artery; Large thrombus burden; Primary percutaneous coronary intervention; ST-elevation myocardial infarction