Relationship Between Infarct Artery, Myocardial Injury, and Outcomes After Primary Percutaneous Coronary Intervention in ST‐Segment–Elevation Myocardial Infarction
Suzanne de Waha, Manesh R. Patel, Hölger Thiele, James E. Udelson, Christopher B. Granger, Ori Ben‐Yehuda, Lak N. Kotinkaduwa, Björn Redfors, Ingo Eitel, Harry P. Selker, Akiko Maehara, Gregg W. Stone
Abstract
Background The extent to which infarct artery impacts the extent of myocardial injury and outcomes in patients with ST‐segment–elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention is uncertain. Methods and Results We performed a pooled analysis using individual patient data from 7 randomized STEMI trials in which myocardial injury within 30 days after primary percutaneous coronary intervention was assessed in 1774 patients by cardiac magnetic resonance (n=1318) or technetium‐99m sestamibi single‐photon emission computed tomography (n=456). Clinical follow‐up was performed at a median duration of 351 days (interquartile range, 184–368 days). Infarct size and outcomes were assessed in anterior (infarct vessel=left anterior descending) versus nonanterior (non–left anterior descending) STEMI. Median infarct size (percentage left ventricular myocardial mass) was larger in patients with anterior compared with nonanterior STEMI (19.7% [interquartile range, 9.4%–31.7%] versus 12.6% [interquartile range, 5.1%–20.5%]; P <0.001). Patients with anterior compared with nonanterior STEMI were at higher risk for 1‐year all‐cause mortality (6.2% versus 3.6%; adjusted hazard ratio [HR], 1.66 [95% CI, 1.02–2.69]; P =0.04) and heart failure hospitalization (4.4% versus 2.6%; adjusted HR, 1.96 [95% CI, 1.15–3.36]; P =0.01). Infarct size was a predictor of subsequent all‐cause mortality or heart failure hospitalization in anterior STEMI (adjusted HR per 1% increase, 1.05 [95% CI, 1.03–1.07]; P <0.001), but not in nonanterior STEMI (adjusted HR, 1.02 [95% CI, 0.99–1.05]; P =0.19). The P value for this interaction was 0.04. Conclusions Anterior STEMI was associated with substantially greater myonecrosis after primary percutaneous coronary intervention compared with nonanterior STEMI, contributing in large part to the worse prognosis in patients with anterior infarction.