SPC365

Failure of percutaneous coronary intervention after ST-segment elevation myocardial infarction: what happens in 5 years?

Session: Posters - E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Speaker: Alexandra Briosa

Congress: CPC 2021
Topic: E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme: 13. Acute Coronary Syndromes
Subtheme: 13.4 Acute Coronary Syndromes – Treatment
Session Type: Posters
FP Number: ---
Authors: Alexandra Briosa; Mariana Martinho; Rita Calé; Ernesto Pereira; Ana Rita F. Pereira; Bárbara Ferreira; Joao Santos; Pedro Santos; Sílvia Vitorino; Catia Eusébio; Gonçalo Jácome Morgado; Cristina Dantas Martins; Rita Miranda; Helder Pereira

<p style="text-align:start"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="font-size:10pt"><span style="font-family:&quot;Calibri Light&quot;,sans-serif">Introduction: </span></span></strong><span style="font-size:10pt"><span style="font-family:&quot;Calibri Light&quot;,sans-serif">Percutaneous coronary intervention (PCI) is one of the most common therapeutic approaches performed worldwide. Despite continuous advances in technical performance, 20% of patients (pts) still have to be submitted to another revascularization procedure within 5 years. Studies about failure of PCI after primary angioplasty are a flaw in the literature.</span></span></span></span></span></p>

<p style="text-align:start"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="font-size:10pt"><span style="font-family:&quot;Calibri Light&quot;,sans-serif">Aim: </span></span></strong><span style="font-size:10pt"><span style="font-family:&quot;Calibri Light&quot;,sans-serif">To evaluate the rate of myocardial revascularization failure (RF) in a group of pts with ST-segment elevation myocardial infarction (STEMI), admitted in a 24h/7day primary PCI center, within 5 years of follow-up (FUP), and to determine the mechanism of RF&nbsp;and its predictors. </span></span></span></span></span></p>

<p style="text-align:start"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="font-size:10pt"><span style="font-family:&quot;Calibri Light&quot;,sans-serif">Methods:</span></span></strong><strong><em> </em></strong><span style="font-size:10pt"><span style="font-family:&quot;Calibri Light&quot;,sans-serif"><span style="color:#333333">Retrospective study of a single center analyzing consecutive pt submitted to primary PCI due to STEMI from 2010 to 2015. Clinical and procedure data were collected, as well as long term outcomes concerning myocardial infarction (MI), need for new revascularization and underlying mechanisms. Multivariate Cox regression analysis was used to identify predictors of PCI failure.</span></span></span></span></span></span></p>

<p style="text-align:start"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="font-size:10pt"><span style="font-family:&quot;Calibri Light&quot;,sans-serif"><span style="color:#333333">Results:&nbsp;</span></span></span></strong><span style="font-size:10pt"><span style="font-family:&quot;Calibri Light&quot;,sans-serif"><span style="color:#333333">909 pts, 73% of the male sex, with a mean age of 63&plusmn;13 years old.&nbsp;14% were submitted to PCI in the past and&nbsp;10% had history of previous MI. Regarding first procedure characteristics:&nbsp;</span></span></span></span></span></span>99,1% were&nbsp;primary angioplasty and&nbsp;0.9% PCI rescue<span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><span style="font-size:10pt"><span style="font-family:&quot;Calibri Light&quot;,sans-serif"><span style="color:#333333">. Revascularization was complete in 64,6% of the pts and it was successful in 95,4% of the cases. The number of complications was extremely low (5,5%) and the most common was PCR (1.9%). </span></span></span></span></span></span></p>

<p style="text-align:start"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><span style="font-size:10pt"><span style="font-family:&quot;Calibri Light&quot;,sans-serif"><span style="color:#333333">During a mean follow-up (FUP) of 67,8&plusmn; 37,6 months, 12,0% of pts needed a new revascularization (mean time to PCI &nbsp;of 21&plusmn; 26 months). Of these 26,7% presented with a new MI. The most common underlying mechanism in those pts was disease progression in 46,5% of the pts, followed by restenosis in 36,4%, and stent thrombosis in 15,2%. 35,6% of pts with disease progression were submitted to other vessel revascularization, being the left anterior descendent the most common artery revascularized. Regarding stent thrombosis, more than a half of the cases were sub-acute stent thrombosis (57%), followed by acute and late chronic thrombosis (21,4%). The treatment of choice in these pts was clot aspiration followed by balloon inflation (53,5%). </span></span></span></span></span></span></p>

<p style="text-align:start"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><span style="font-size:10pt"><span style="font-family:&quot;Calibri Light&quot;,sans-serif"><span style="color:#333333">For our population, 5-year RF&nbsp;predictors were: previous history of MI (HR 2.9, 95% CI 1,44-5,75, p = 0.003) and multivessel disease (HR 2,25, 95% CI 1,44-3,51, p&lt; 0.001).</span></span></span></span></span></span><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><span style="font-size:10pt"><span style="font-family:&quot;Calibri Light&quot;,sans-serif"><span style="color:#333333">Stent thrombosis mechanism was associated with higher mortality rates compared to other mechanisms (p=0.002, see figure). </span></span></span></span></span></span></p>

<p style="text-align:start"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="font-size:10pt"><span style="font-family:&quot;Calibri Light&quot;,sans-serif"><span style="color:#333333">Conclusion: </span></span></span></strong><span style="font-size:10pt"><span style="font-family:&quot;Calibri Light&quot;,sans-serif"><span style="color:#333333">A considerable proportion of pts require repeat revascularization procedure after primary PCI during 5-years FUP. <strong>&nbsp;</strong>The most common underlying mechanism was progression of the disease, as it was expected. Pts with history of recurrent MI and multivessel disease were identified at increase risk of failure of revascularization at long term, which suggests that they may benefit from a more aggressive preventive and surveillance strategies.&nbsp; </span></span></span></span></span></span></p>