Author + information
- Manu Kaushik,
- Alok Saurav,
- Satish Chandraprakasam,
- Venkata Alla,
- Anand Deshmukh,
- Michael Del Core,
- Aryan Mooss and
- Dennis Esterbrooks
While, proximal right coronary artery (RCA) occlusion in patients with inferior STEMI would suggest right ventricular (RV) involvement, the effect of location of RCA occlusion on outcomes has not been studied. We sought to evaluate the impact of site of occlusion of RCA on outcomes of patients with inferior STEMI undergoing PCI.
All patients presenting to a tertiary care center between June 2006 & May 2012 with STEMI & undergoing PCI with RCA as the culprit vessel were included. Patients with proximal RCA occlusion were compared to patients with distal RCA occlusion based on whether the occlusion was proximal or distal to major right ventricular branch take-off. Patients with posterior descending branch or posterolateral branch occlusion were excluded to correct for left ventricular myocardium at risk in both comparison groups. Clinical & outcome variables were retrieved from retrospective chart review.
One hundred, ninety-seven patients were analyzed of which, 94 patients had proximal RCA & 103 had distal RCA occlusion. The groups were similar with respect to gender, prevalence of hypertension, hyperlipidemia, diabetes mellitus, smoking, chronic pulmonary disease & timely revascularization. Major adverse cardiovascular events (MACE) defined as combined incidence of cardiogenic shock, IABP use, cardiac arrest & death was similar in the two groups (21.3% vs 18.4%;p >0.05). Individual event rates for cardiogenic shock, IABP use, death, cardiogenic shock & hypotension were also statistically similar in both groups. Left ventricular EF was similar in both groups (46.8 vs 47.2%;p = 0.77) as was the duration of hospitalization (5.06 vs 5.17 days;p = 0.75). No clinical variables predicted MACE. Time to revascularization > 6 hours from symptom onset trended towards predicting MACE (OR=0.50 [95% CI 0.24–1.05], p = 0.06).
In patients presenting with inferior STEMI undergoing PCI, lesion location with respect to the right ventricular branch origin does not predict major adverse cardiovascular events Proximal lesion location in RCA in STEMI patients may not be used as a surrogate for clinically RV involvement.
Poster Sessions, Expo North
Saturday, March 09, 2013, 3:45 p.m.-4:30 p.m.
Session Title: STEMI Topics
Abstract Category: 1. Acute Coronary Syndromes: Clinical
Presentation Number: 1171-205
- 2013 American College of Cardiology Foundation