Impact of Non-Infarct-Related Artery Disease on Infarct Size and Outcomes (from the CRISP-AMI Trial)

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• 作者：Rohan Shah ; BS^a ; Robert M. Clare ; MS^a ; Karen Chiswell ; PhD^a ; W. Schuyler Jones ; MD^a ; ^b ; A. Sreenivas Kumar ; MD ; DM^c ; Holger Thiele ; MD^d ; Richard W. Smalling ; MD ; PhD^e ; Praveen Chandra ; MD^f ; Marc Cohen ; MD^g ; Divaka Perera ; MD^h ; Derek P. Chew ; MDⁱ ; John K. French ; MBChB ; PhD^j ; Jonathan Blaxill ; MD^k ; E. Magnus Ohman ; MD^a ; ^b ; Manesh R. Patel ; MD^a ; ^b ; ^{manesh.patel@duke.edu" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Heart failure ; Infarct-related artery ; Non-infarct-related artery ; ST-segment elevation myocardial infarction
• 刊名：The American Journal of Medicine
• 出版年：2016
• 出版时间：December 2016
• 年：2016
• 卷：129
• 期：12
• 页码：1307-1315
• 全文大小：213 K

文摘

Non-infarct-related artery (non-IRA) disease is prevalent in patients with ST-segment elevation myocardial infarction (STEMI). We aimed to assess the impact of non-IRA disease on infarct size and clinical outcomes in patients with acute STEMI.

Methods

The Counterpulsation to Reduce Infarct Size Pre-PCI Acute Myocardial Infarction (CRISP-AMI) trial randomized patients to intra-aortic balloon counterpulsation (IABC) vs no IABC prior to percutaneous coronary intervention in patients with acute STEMI. Infarct size (% left ventricular mass) at 3-5 days post percutaneous coronary intervention and 6-month clinical outcomes were compared between patients with and without non-IRA disease (defined as ≥50% stenosis in at least one non-IRA).

Results

A total of 324 (96.1%) patients had anterior STEMI, of whom 34.9% had non-IRA disease. There was no difference in infarct size (% left ventricular mass) between patients with and without non-IRA disease (median 39% vs 39%; P = .73). At 6 months, there was no difference in rates of recurrent myocardial infarction (0.9% vs 0.9%; P = .78), major Thrombolysis In Myocardial Infarction bleeding (0.9% vs 0.5%; P = .77), or all-cause death (3.5% vs 2.4%; P = .61) in patients with and without non-IRA disease, respectively. Patients with non-IRA disease had a higher rate of new/worsening heart failure with hospitalization (8.8% vs 1.9%; P = .0050).

Conclusions

More than one-third of patients with anterior STEMI in the CRISP-AMI study had non-IRA disease. These patients had similar infarct sizes and rates of recurrent myocardial infarction, major bleeding, and all-cause death. Patients with non-IRA disease did have a higher rate of new/worsening heart failure with hospitalization. Further study is needed to understand the mechanisms of outcomes of patients with non-IRA disease.