Abstract 2029: The Incidence, Predictors and Outcome of New Lesions Treated With Percutaneous Coronary Intervention in Patients Presenting with Myocardial Infarction
Patients presenting with ST elevation myocardial infarction (STEMI) often require percutaneous treatment of lesion not targeted at the time of the primary percutaneous coronary intervention (PCI). This study aimed to detect the incidence, predictors and outcome of recurrent PCI that was not staged and not related to the initial treatment of the STEMI. Between January 2003 and December 2005, 1007 consecutive patients presenting with a STEMI were screened. Of these 94 (10.5%) pts returned within 36 months for a second PCI, not planned and not related to the index procedure at the time of the primary PCI. The baseline and the angiographic features of these patients were compared to 913 patients who did not require a subsequent PCI. Patients who were subjected for subsequent PCI were followed clinically for additional 12 months for major adverse cardiovascular events (MACE) including death, MI and target lesion revascularization (TLR). The median time to the second PCI was 396 days. The clinical presentation at the time of the recurrent PCI was a non-ST-elevation ACS in 46.1% and a new ST elevation in 9.7%. Independent predictors of recurrent PCI occurrence are detailed in the table⇓. At 1 year after the recurrent PCI, there were 9 (9.6%) deaths, 4 Q-Wave MI (4.3%), 4 TLR (4.3%) and 17 MACE (18%). Following STEMI, nearly 10% of patients experiencing a cardiac event that requires subsequent unplanned PCI unrelated to the initial PCI. Patients with diabetes and peripheral vascular disease are at high risk to develop such an event which is associated with high mortality and morbidity. Aggressive preventive and medical management should be applied to this population for prevention of these subsequent events.