Abstract 4682: Impact of Multivessel Coronary Artery Disease on Early Ischemic Injury, Late Clinical Outcome and Remodeling in Patients With Acute Myocardial Infarction Treated by Primary Coronary Angioplasty
Background Multi-Vessel Disease (MVD) adversely affects the outcome of ST elevation myocardial infarction (STEMI) patients. We assessed whether the impact of MVD on outcome of STEMI patients is due to ischemic damage after Primary Percutaneous Coronary Intervention (PPCI) or to recurrent ischemic events.
Methods From August 2004 to August 2006, 288 STEMI patients treated by bare metal stent-PPCI were prospectively enrolled. In MVD (n=134), stenting of non-culprit lesions was not always attempted at index PPCI. The ischemic injury after PPCI (by multiparametric approach) and the incidence of late adverse cardiovascular events were compared between the two groups.
Results Compared with single-VD, MVD patients were older, with higher prevalence of diabetes, prior MI, anterior MI and higher collateral score. Myocardial perfusion as assessed by myocardial blush grade and ∑ST-segment resolution was similar in the two groups as well as the infarct size and microvascular obstruction as assessed by Troponin I and by delayed enhancement cardiac magnetic resonance. At clinical (98% complete) and echocardiographic (94% complete) follow-up (median 32 months) MVD patients showed an higher incidence of death/MI/stroke/re-PCI (figure 1A⇓) and worse ventricular remodeling (≥20% increase in end diastolic volume index compared to baseline) than single-VD patients (figure 1B⇓). At propensity adjusted analysis MVD was an independent predictor of re-MI (OR 5.7) and ventricular remodeling (OR 2.2).
Conclusions The impact of MVD on clinical outcome and remodeling of STEMI patients is not due to the extent of ischemic damage after PPCI, but to recurrent ischemic events during follow-up.