Author + information
- Mariusz Tomaniak1,
- Dominika Klimczak2,
- Maria Tovar3,
- Marcella De Paolis4,
- Joost Daemen5,
- Jeroen Wilschut6,
- Peter de Jaegere7,
- Felix Zijlstra8,
- Nicolas Van Mieghem9 and
- Roberto Diletti10
- 1Thorax Center, Erasmus MC, Department of Interventional Cardiology, Rotterdam, Netherlands, Medical University of Warsaw, First Department of Cardiology, Warsaw, Poland
- 2Thorax Centre, Erasmus MC, Department of Interventional Cardiology, Rotterdam, Netherlands, Medical University of Warsaw, Department of Immunology, Transplant Medicine and Internal Diseases, Division of Heart Failure and Cardiac Rehabilitation, Warsaw, Poland
- 3Thorax Centre, Erasmus MC, Department of Interventional Cardiology, Rotterdam, Netherlands
- 4Thoraxcenter, Erasmus MC, Department of Interventional Cardiology - Santa Maria Hospital, Terni, Italy, Rotterdam, Terni, Terni, Italy
- 5Erasmus MC - Thoraxcenter, United States
- 6Thoraxcenter Erasmus MC, Rotterdam, Netherlands
- 7Department of Cardiology, Erasmus MC, Rotterdam, Netherlands
- 8Thoraxcenter, Erasmus Medical Centre, Rotterdam, Netherlands
- 9Thoraxcenter, Erasmus Medical Center, Rotterdam, Netherlands
- 10Thorax Center, Erasmus MC, Rotterdam, Netherlands
Among patients with re-infarction (ReMI) that occurred after ST-segment elevation myocardial infarction (STEMI), the impact of ReMI etiology on the long-term prognosis is not clearly established. The study aims to compare the influence of stent thrombosis (ST) and non-stent-related recurrent myocardial infarction (NS-ReMI) on prognosis after primary percutaneous coronary intervention (PCI).
This is a single-centre observational study evaluating the impact of ST and NS-ReMI in patients with prior STEMI and already treated with primary PCI. Patients included in the present analysis had at least 1-year follow-up after ReMI and clinical events were compared between ST-related ReMI (ST-ReMI) and NS-ReMI groups.
A total of 4226 STEMI patients treated with primary PCI with a median follow up of 1131 days (IQR 777 – 1753) were evaluated. ReMI occurred in 217 (5.2%) patients and in 190 a minimum follow-up of one year after ReMI was available (median follow-up after ReMI 1707 days (IQR 1001 – 2591). ST-ReMI was identified in 109 (57.4%) patients. ST-ReMI occurred earlier after index PCI than NS-ReMI (time to ReMI: 365.9 ± 530.8 vs. 960.1 ± 986.3, p = 0.001). In ST-ReMI patients a higher mortality was observed at one year (11.9% vs. 3.7%, p = 0.044). The second ReMI (8.3% vs. 7.4%, p = 0.830) occurred with similar frequency in both groups. Landmark survival analysis performed at 30 days after ReMI revealed higher rate of death at 30 days post-reinfarction in ST-ReMI group (7.0% vs. 3.0%, p = 0.029) followed by similar rate of death between 30 days and 1 year after ReMI (5.0% vs 2.5%, p = 0.391). At multivariate Cox regression analysis adjusted for confounders with p < 0.1, ST as an etiology of ReMI remained an independent predictor of mortality (HR 2.59, 95% CI: 1.09-6.17, p = 0.030).
In STEMI population prognosis after ReMI differs based on its etiology. ReMI caused by ST is associated with higher mortality as compared to NS-ReMI at one-year follow-up, which is mainly related to the events occurring within one month post ReMI.
CORONARY: Acute Myocardial Infarction