Current guidelines advocate primary percutaneous coronary intervention as the therapy
of choice for ST-segment elevation myocardial infarction (STEMI) when available. Little
is known about the outcomes of patients without a culprit lesion after referral for
primary percutaneous coronary intervention for a presumed STEMI. Subjects were identified
within a registry containing consecutive patients who underwent emergent angiography
for a potential STEMI from October 2008 to July 2012. Vital status was obtained from
the medical record and Social Security Death Index. Cox proportional hazards models
were created to evaluate the relation between the angiographic findings and cardiovascular
outcomes, including major adverse cardiovascular events (MACE) and mortality. Among
539 patients who underwent emergent angiography, 65 (12%) had no coronary artery disease
(CAD), 110 (20%) had CAD without a culprit lesion, and 364 (68%) had a culprit lesion.
Kaplan-Meier analysis of MACE demonstrated that patients with CAD who lack a culprit
lesion had a similar rate of MACE to those with a culprit lesion (p = 0.64), and both
groups had significantly increased risk compared with those with no CAD (hazard ratio
[HR] 1.9, 95% confidence interval [CI] 1.01 to 3.41 and HR 2.0, 95% CI 1.15 to 3.54,
respectively). Kaplan-Meier analysis of mortality illustrated a nonsignificant trend
toward increased mortality in patients having a culprit lesion (HR 1.7, 95% CI 0.59
to 4.80) and those having CAD without a culprit lesion (HR 1.2, 95% CI 0.39 to 3.81)
compared with those with no CAD. In conclusion, patients found to have CAD without
a culprit lesion in emergent angiography after a presumptive STEMI diagnosis have
similar long-term rates of MACE compared with those requiring emergent revascularization.
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Article info
Publication history
Published online: September 23, 2013
Accepted:
August 6,
2013
Received in revised form:
August 6,
2013
Received:
June 28,
2013
Footnotes
See page 1749 for disclosure information.
Identification
Copyright
© 2013 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
