Vidal-Calés Pablo, Bujak Kamil, Rinaldi Riccardo, Salazar-Rodríguez Anthony, Ortega-Paz Luis, Gómez-Lara Josep, Jiménez-Díaz Víctor, Jiménez Marcelo, Jiménez-Quevedo Pilar, Diletti Roberto, Bordes Pascual, Campo Gianluca, Silvestro Antonio, Maristany Jaume, Flores Xacobe, Miguel-Castro Antonio De, Íñiguez Andrés, Ielasi Alfonso, Tespili Maurizio, Lenzen Mattie, Gonzalo Nieves, Tebaldi Matteo, Biscaglia Simone, Romaguera Rafael, Gómez-Hospital Joan Antoni, Serruys Patrick W, Sabaté Manel, Brugaletta Salvatore
Instituto Clínic Cardiovascular, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, España Instituto Clínic Cardiovascular, Hospital Clínic Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) University of Barcelona Barcelona España.
3rd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Polonia 3rd Department of Cardiology Faculty of Medical Sciences in Zabrze Medical University of Silesia Katowice Polonia.
REC Interv Cardiol. 2025 Jan 29;7(2):99-108. doi: 10.24875/RECIC.M24000491. eCollection 2025 Apr-Jun.
There is limited data on the impact of the culprit vessel on very long-term outcomes after ST-elevation myocardial infarction (STEMI). The aim was to analyze the impact of the left anterior descending coronary artery (LAD) as the culprit vessel of STEMI on very long-term outcomes.
We analyzed patients included in the EXAMINATION-EXTEND study (NCT04462315) treated with everolimus-eluting stents or bare-metal stents after STEMI (1498 patients) and stratified according to the culprit vessel (LAD vs other vessels). The primary endpoint was the patient-oriented composite endpoint (POCE), including all-cause mortality, myocardial infarction (MI) or revascularization at 10 years. Secondary endpoints were individual components of POCE, device-oriented composite endpoint and its individual components and stent thrombosis. We performed landmark analyses at 1 and 5 years. All endpoints were adjusted with multivariable Cox regression models.
The LAD was the culprit vessel in 631 (42%) out of 1498 patients. The LAD-STEMI group had more smokers, advanced Killip class and worse left ventricular ejection fraction. Conversely, non-LAD-STEMI group showed more peripheral vascular disease, previous MI, or previous PCI. At 10 years, no differences were observed between groups regarding POCE (34.9% vs 35.4%; adjusted hazard ratio [HR], 0.95; 95% confidence interval [95%CI], 0.79-1.13; = .56) or other endpoints. The all-cause mortality rate was higher in the LAD-STEMI group ( = .041) at 1-year.
In a contemporary cohort of STEMI patients, there were no differences in POCE between LAD as the STEMI-related culprit vessel and other vessels at 10 years follow-up. However, all-cause mortality was more common in the LAD-STEMI group within the first year after STEMI.
关于罪犯血管对ST段抬高型心肌梗死（STEMI）后极长期预后的影响，相关数据有限。本研究旨在分析作为STEMI罪犯血管的左前降支冠状动脉（LAD）对极长期预后的影响。
我们分析了EXAMINATION - EXTEND研究（NCT04462315）中STEMI后接受依维莫司洗脱支架或裸金属支架治疗的患者（1498例），并根据罪犯血管（LAD与其他血管）进行分层。主要终点是患者导向性复合终点（POCE），包括10年时的全因死亡率、心肌梗死（MI）或血运重建。次要终点是POCE的各个组成部分、器械导向性复合终点及其各个组成部分以及支架血栓形成。我们在1年和5年时进行了里程碑分析。所有终点均采用多变量Cox回归模型进行调整。
1498例患者中有631例（42%）的罪犯血管为LAD。LAD - STEMI组吸烟者更多、Killip分级更高且左心室射血分数更差。相反，非LAD - STEMI组外周血管疾病、既往MI或既往PCI更多。10年时，两组在POCE（34.9%对35.4%；调整后风险比[HR]，0.95；95%置信区间[95%CI]，0.79 - 1.13；P = 0.56）或其他终点方面未观察到差异。1年时，LAD - STEMI组的全因死亡率更高（P = 0.041）。
在当代STEMI患者队列中，随访10年时，作为STEMI相关罪犯血管的LAD与其他血管在POCE方面无差异。然而，STEMI后第一年，LAD - STEMI组全因死亡率更为常见。
