Is coronary multivessel disease in acute myocardial infarction patients still associated with worse clinical outcomes at 1‐year?

Abstract

Background ST‐elevation myocardial infarction (STEMI) patients with multivessel disease (MVD) are associated with a worse prognosis. However, few comparisons are available according to coronary status in the era of modern reperfusion and optimized secondary prevention. Hypothesis We hypothesized that the difference in prognosis according to number of vessel disease in STEMI patients has reduced. Methods All consecutive STEMI patients undergoing primary percutaneous coronary intervention (PCI) within 24 h of symptoms onset between January 1, 2014 and June 30, 2016 enrolled in the CRAC (Club Régional des Angioplasticiens de la région Centre) France PCI registry were analyzed. Baseline characteristics, management, and outcomes at 1‐year were analyzed according to coronary status (one‐, two‐, and three‐VD). Results A total of 1886 patients (mean age 62.2 ± 14.0 year; 74% of male) were included. Patients with MVD (two or three‐VD) represented 53.7%. They were older with higher cardiovascular risk factor profile. At 1 year, the rate of major adverse cardiovascular events (MACE, defined as all‐cause death, stroke or re‐MI) was 10%, 12%, and 12% in one‐, two, and three‐VD respectively (p = .28). In multivariable adjusted Cox proportional hazard regression model, two‐ and three‐VD were not associated with higher rate of MACE compared to patients with single VD (HR, 1.09; 95%CI 0.76–1.56 for two‐VD; HR, 0.74; 95%CI 0.48–1.14 for three‐VD). Conclusions MVD still represents an important proportion of STEMI patients but their prognoses were not associated with worse clinical outcomes at 1‐year compared with one‐VD patients in a modern reperfusion area and secondary medication prevention.

Serum Exosomal MicroRNA-186-5p Positively Correlates with Lipid Indexes, Coronary Stenosis Degree, and Major Adverse Cardiovascular Events in Coronary Heart Disease

“…The incidence of MACE at 1 year and 2 years ranges from 2.7% to 12% and 6% to 30%, accordingly, in CHD patients by other studies (Bauersachs et al 2019, Berger et al 2020, Ferencik et al 2018, Puymirat et al 2021. In this study, the accumulating MACE rate at 1 year was 6.6% and the rate at 2 years was 15.6% in CHD patients.…”

Clinical outcomes guided by quantitative flow ratio in multivessel disease and ST-elevation myocardial infarction patients with diabetes mellitus

“…Patients with DM have more complex coronary anatomy (more frequently multivessel and diffuse epicardial CAD with calci cation and negative remodeling, often with microvascular disease), more high risk lipidic "vulnerable" plaques, more frequent comorbidities (including hypertension, renal dysfunction, and heart failure), and a higher risk of stent-related complications, including thrombosis and restenosis, compared with patients without diabetes [2][3][4]. Multivessel disease and ST-elevation myocardial infarction (MVD-STEMI) patients had worst prognosis in different types of CAD [5]. The addition of diabetes increased the incidence of clinical outcomes in MVD-STEMI patients [6].…”