Impact of Occluded Culprit Arteries on Long‐Term Clinical Outcome in Patients with Non‐ST‐Elevation Myocardial Infarction: 48‐Month Follow‐Up Results in the COREA‐AMI Registry |
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| Authors: | DONG IL SHIN MD KIYUK CHANG MD YOUNGKEUN AHN MD BYUNG‐HEE HWANG MD HUN‐JUN PARK MD SEOK MIN SEO MD YOON‐SEOK KOH MD PUM‐JOON KIM MD KI‐BAE SEUNG MD MYUNG HO JEONG MD |
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| Institution: | 1. Cardiovascular Center, Incheon St. Mary's Hospital, The Catholic University of Korea, , Incheon, South Korea;2. Cardiovascular Center, Seoul St. Mary's Hospital, The Catholic University of Korea, , Seoul, South Korea;3. Cardiovascular Center, Chonnam National University Hospital, Chonnam National University, , Gwangju, South Korea;4. Cardiovascular Center, St. Paul's Hospital, The Catholic University of Korea, , Seoul, South Korea;5. Cardiovascular Center, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, , Uijeongbu, South Korea |
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| Abstract: | Background The prognostic impact of occluded culprit arteries in non‐ST‐elevation myocardial infarction (NSTEMI) patients beyond 12 months has not been investigated. Objectives The impact of occluded culprit arteries on a composite of cardiac death (CD), recurrent nonfatal MI (RMI), and target vessel revascularization (TVR) in patients who presented with NSTEMI was investigated during a 48‐month follow‐up using propensity‐score (PS) matching. Methods A total of 2,878 NSTEMI patients in the COREA‐AMI (COnvergent REgistry of cAtholic and chonnAm university for Acute MI) Registry were classified according to the angiographic flow of culprit arteries (occlusion OC], n = 1,070; nonocclusion, n = 1,808). After PS matching, the incidence of the primary end‐point, a composite of CD, RMI, and TVR was compared. Results The median follow‐up duration was 47.3 months (IQR 32.7–66.2). In the PS‐matched population, the 48‐month cumulative rates of the primary end‐point (27.5% vs. 17.9%, P < 0.001) and each event were higher in the OC group (CD: 9.0% vs. 5.4%, RMI: 16.3% vs. 9.4%, TVR: 10.5% vs. 5.6%, respectively, P < 0.05). In multivariate Cox regression analysis, occluded culprit arteries showed the significant statistical impact on the primary end‐point (HR 1.689 1.385–2.059], P < 0.001) and each event (CD: 1.736 1.218–2.475], RMI: 1.918 1.468–2.505], TVR: 2.042 1.453–2.869], respectively, P < 0.05). Furthermore, in the 12‐month landmark analysis, occluded culprit arteries were still associated with higher risk of primary end‐point beyond 12 months (P < 0.001). Conclusions Occluded culprit arteries were independently associated with the higher risk of CD, RMI, and TVR in NSTEMI patients during the 48‐month follow‐up. (J Interven Cardiol 2014;27:12–20) |
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