SPC365

Anterior versus non-anterior STEMI: incidence of reinfarction and all-cause mortality at long-term follow-up

Session: Posters (Sessão 2 - Écran 6) - Enfarte Agudo do Miocárdio 1
Speaker: André Filipe Macedo Alexandre

Congress: CPC 2023
Topic: E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme: 13. Acute Coronary Syndromes
Subtheme: 13.7 Acute Coronary Syndromes - Other
Session Type: Pósters Electrónicos
FP Number: ---
Authors: André Alexandre; David Sá-Couto; André Luz; João Faria; Andreia Campinas; Anaisa Pereira; Mariana Santos; Raquel Santos; Bruno Brochado; João Silveira; Severo Torres

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><u><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Introduction</span></span></u><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">: Anterior STEMI due to left main stem (LMS) or left anterior descending (LAD) coronary artery occlusion has been associated with worse short-term outcomes and overall worse prognosis. Nevertheless, there is still conflicting data about the long-term risk of reinfarction and target vessel failure (TVF) in relation to the culprit vessel in STEMI patients.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><u><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Aim</span></span></u><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">: To determine whether the culprit vessel in STEMI patients has influence on long-term incidence of reinfarction, TVF, and all-cause mortality.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><u><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Methods</span></span></u><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">: This is a retrospective study of STEMI patients admitted to primary PCI between Jan 2008 to Dec 2013 and followed for 8 year-interval. Patients were classified according to the culprit vessel in two groups: anterior STEMI (LAD or LMS) vs non-anterior STEMI (circumflex [CX] or right coronary artery [RCA]). The primary endpoint was reinfarction. The secondary endpoints were target vessel failure (TVF) and all-cause mortality.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><u><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Results</span></span></u><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">: From a total of 584 STEMI patients, 532 were alive at discharge and considered for the analysis. 74% were male; median age was 61 years. Mean follow-up time was 6.94 (&plusmn;2.38) years. The most common culprit vessel was RCA (45.5%), followed by LAD (41.2%), CX (13.2%), and LMS (0.20%). Regarding the two main groups, 220 (41.4%) patients had an anterior STEMI and 312 (58.6%) patients had non-anterior STEMI. There were no significant differences between groups regarding baseline clinical characteristics, except for peripheral artery disease (less common in the anterior STEMI group: 4% vs 11%; p=0.011). The anterior STEMI group presented at a higher Killip class (20% vs 15%; p=0.046) and had higher hs-troponin T peak value (6.16 vs 3.66 ng/mL; p&lt;0.001). A reduced left ventricular ejection fraction (LVEF) at discharge was also more common in the anterior STEMI group (78% vs 43%; p&lt;0.001). In terms of angiographic characteristics, multivessel disease was more common in the non-anterior STEMI group (61% vs 50%; p=0.005), as well as PCI of non-culprit vessels (23% vs 16%; p=0.037) and the use of bare-metal stents (52% vs 20%; p&lt;0.001). Regarding the primary endpoint, multivariate analysis with Cox regression revealed that non-anterior STEMI was independently associated with a higher risk of reinfarction which persisted after relevant variable adjustment (adjusted HR 1.96; 95% CI 1.08-3.67; p=0.027) when compared to anterior STEMI group. Regarding the secondary endpoints (TVF and all-cause mortality), there were no significant differences between groups.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><u><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Conclusion</span></span></u><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">: Although anterior STEMI is related to reduced LVEF at discharge and leads to worse short-term prognosis, our study showed that non-anterior STEMI is associated with an increased risk of reinfarction at long-term follow-up, with no differences in TVF or all-cause mortality.</span></span></span></span></p>