Author + information
- Jaclyn Carberry,
- David Carrick,
- Caroline Haig,
- Margaret McEntegart,
- Mark Petrie,
- M. Mitchell Lindsay,
- Stuart Hood,
- Stuart Watkins,
- Andrew Davie,
- Ahmad Mahrous,
- Aadil Shaukat,
- Ian Ford,
- Keith Oldroyd and
- Colin Berry
Background: The prognostic importance of the burden of coronary artery disease in patients with acute ST-elevation myocardial infarction (STEMI) is reasonably well understood, but the nature and extent of plaque complexity is less well described. We aimed to define the extent of complex plaques in a STEMI population and determine if the presence of multiple complex plaques remained a predictor of longer term health outcome.
Methods: STEMI patients were enrolled in a single center cohort study (BHF MR-MI; NCT02072850). Coronary angiograms were independently analyzed by two trained observers. A third resolved disagreement. A complex plaque was a lesion ≥30% stenosis with ≥2 adverse features: presence of a filling defect/thrombus, ulceration, irregularity, TIMI flow <3, moderate/severe calcification and bifurcation (Keeley et al, Am J Cardiol, 2014). Patients who had more than one complex plaque stented at the index procedure were excluded. Patient outcomes were independently reviewed for all-cause death or heart failure hospitalization. Patients with single and multiple complex plaques were compared to assess the clinical and prognostic associations of multiple complex plaques.
Results: Of 324 patients with STEMI, 293 (90%) patients who had at least one complex plaque and one or no complex plaques stented were included in the main analysis. 234 (80%) had a single complex plaque and 59 (20%) had multiple complex plaques (47 (16%) with 2, 9 (3%) with 3, 2 (1%) with 4 and 1 (<1%) with 5). In multivariable logistic regression, patients with multiple complex plaques were older (p<0.001) and had higher heart rates on admission (p=0.046).
Following discharge, 28 (10%) patients experienced all-cause death or heart failure hospitalization and the presence of multiple complex plaques was an associate of this composite outcome (n=10 in multiple, n=18 in single complex plaques; HR 2.51 (1.15, 5.47); p=0.021). This association persisted independently of infarct size (p=0.020).
Conclusions: Patients with multiple complex plaques were two and half times more likely to die or experience heart failure within 4 years of discharge, when complexity was defined as a lesion with stenosis ≥30% and ≥2 adverse features.
Poster Hall, Hall C
Saturday, March 18, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Acute Coronary Syndromes, Diagnosis, Management and Outcomes
Abstract Category: 2. Acute and Stable Ischemic Heart Disease: Clinical
Presentation Number: 1253-333
- 2017 American College of Cardiology Foundation