Extent, Location, and Clinical Significance of Non–Infarct-Related Coronary Artery Disease Among Patients With ST-Elevation Myocardial Infarction

Park, Duk‐Woo; Clare, Robert; Schulte, Phillip J.; Pieper, Karen S.; Shaw, Linda K.; Califf, Robert M.; Ohman, E. Magnus; Werf, Frans Van de; Hirji, Sameer; Harrington, Robert A.; Armstrong, Paul W.; Granger, Christopher B.; Jeong, Myung Ho; Patel, Manesh R.

doi:10.1001/jama.2014.15095

Cited by 308 publications

(157 citation statements)

References 32 publications

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“…Our study further extends these conclusions to patients with STEMI who underwent PCI in nIRA CTO as shown in another meta‐analysis of contemporary RCTs in patients with STEMI with multivessel CAD 7. The idea that patients with acute STEMI and concurrent nIRA CTO would demonstrate clinical benefit from CTO PCI was generated from the apparent 2‐fold increased mortality and morbidity rates among patients with STEMI and multivessel CAD and CTO 4, 5, 21. Even among patients without STEMI, increased mortality has been attributed to the presence of CTOs in nIRAs 3, 6.…”

Section: Discussionsupporting

confidence: 69%

“…The treatment of choice for STEMI is percutaneous coronary intervention (PCI) to restore blood flow to the occluded infarct‐related artery 1, 2. Approximately 50% of patients presenting with STEMI are found to have multivessel coronary artery disease (CAD) with concomitant stenotic lesions in noninfarct‐related arteries (nIRAs) and ≈12% to 13% are found to have a chronic total occlusion (CTO) in an nIRA 3, 4. Prior studies have shown that the presence of a CTO in an nIRA in patients with STEMI is linked to an increase in short‐ and long‐term mortality 4, 5.…”

mentioning

confidence: 99%

“…Approximately 50% of patients presenting with STEMI are found to have multivessel coronary artery disease (CAD) with concomitant stenotic lesions in noninfarct‐related arteries (nIRAs) and ≈12% to 13% are found to have a chronic total occlusion (CTO) in an nIRA 3, 4. Prior studies have shown that the presence of a CTO in an nIRA in patients with STEMI is linked to an increase in short‐ and long‐term mortality 4, 5. Moreover, it has been suggested that the presence of a CTO is associated with worse outcomes compared with the presence of multivessel CAD without a CTO 3, 5, 6.…”

mentioning

confidence: 99%

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Staged Percutaneous Intervention for Concurrent Chronic Total Occlusions in Patients With ST‐Segment–Elevation Myocardial Infarction: A Systematic Review and Meta‐Analysis

Villablanca

Olmedo

Weinreich

et al. 2018

JAHA

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BackgroundStudies have shown that chronic total occlusion (CTO) in a noninfarct‐related artery in patients with ST‐segment–elevation myocardial infarction is linked to increased mortality. It remains unclear whether staged revascularization of a noninfarct‐related artery CTO in patients with ST‐segment–elevation myocardial infarction translates to improved outcomes. We performed a meta‐analysis to compare outcomes between patients presenting with ST‐segment–elevation myocardial infarction with concurrent CTO who underwent percutaneous coronary intervention of noninfarct‐related artery CTO versus those who did not.Method and ResultsWe conducted an electronic database search of all published data. The primary end point was major adverse cardiovascular events. Secondary end points were all‐cause mortality, cardiovascular mortality, myocardial infarction, repeat revascularization with either percutaneous coronary intervention or coronary artery bypass grafting, stroke, and heart failure readmission. Odds ratios (ORs) and 95% confidence intervals (CIs) were computed. Random effects model was used and heterogeneity was considered if I 2 >25. Six studies (n=1253 patients) were included in the analysis. There was a significant difference in major adverse cardiovascular events (OR, 0.54; 95% CI, 0.32–0.91), cardiovascular mortality (OR, 0.43; 95% CI, 0.20–0.95), and heart failure readmissions (OR, 0.57; 95% CI, 0.36–0.89), favoring the patients in the CTO percutaneous coronary intervention group. No significant differences were observed between the 2 groups for all‐cause mortality (OR, 0.47; 95% CI, 0.22–1.00), myocardial infarction (OR, 0.78; 95% CI, 0.41–1.46), repeat revascularization (OR, 1.13; 95% CI, 0.56–2.27), and stroke (OR, 0.51; 95% CI, 0.20–1.33).ConclusionsIn this meta‐analysis, CTO percutaneous coronary intervention of the noninfarct‐related artery in patients presenting with ST‐segment–elevation myocardial infarction was associated with a significant reduction in major adverse cardiovascular events, cardiovascular mortality, and heart failure readmissions.

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Section: Discussionsupporting

confidence: 69%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Staged Percutaneous Intervention for Concurrent Chronic Total Occlusions in Patients With ST‐Segment–Elevation Myocardial Infarction: A Systematic Review and Meta‐Analysis

Villablanca

Olmedo

Weinreich

et al. 2018

JAHA

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“…Between April 2013 and July 2015, we recruited 42 patients (62±9 years) from routine coronary angiography waiting lists, in 2 distinct groups (Figure 1): Patients with obstructive coronary stenoses (n=32): defined by either a coronary artery stenosis >50% on quantitative coronary angiography15 or fractional flow reserve ≤0.8 16. These patients had typical anginal symptoms and multiple risk factors, or known obstructive coronary artery stenoses awaiting percutaneous coronary intervention.…”

Section: Methodsmentioning

confidence: 99%

Deleterious Effects of Cold Air Inhalation on Coronary Physiological Indices in Patients With Obstructive Coronary Artery Disease

Williams

Asrress

Lumley

et al. 2018

JAHA

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BackgroundCold air inhalation during exercise increases cardiac mortality, but the pathophysiology is unclear. During cold and exercise, dual‐sensor intracoronary wires measured coronary microvascular resistance (MVR) and blood flow velocity (CBF), and cardiac magnetic resonance measured subendocardial perfusion.Methods and ResultsForty‐two patients (62±9 years) undergoing cardiac catheterization, 32 with obstructive coronary stenoses and 10 without, performed either (1) 5 minutes of cold air inhalation (5°F) or (2) two 5‐minute supine‐cycling periods: 1 at room temperature and 1 during cold air inhalation (5°F) (randomized order). We compared rest and peak stress MVR, CBF, and subendocardial perfusion measurements. In patients with unobstructed coronary arteries (n=10), cold air inhalation at rest decreased MVR by 6% (P=0.41), increasing CBF by 20% (P<0.01). However, in patients with obstructive stenoses (n=10), cold air inhalation at rest increased MVR by 17% (P<0.01), reducing CBF by 3% (P=0.85). Consequently, in patients with obstructive stenoses undergoing the cardiac magnetic resonance protocol (n=10), cold air inhalation reduced subendocardial perfusion (P<0.05). Only patients with obstructive stenoses performed this protocol (n=12). Cycling at room temperature decreased MVR by 29% (P<0.001) and increased CBF by 61% (P<0.001). However, cold air inhalation during cycling blunted these adaptations in MVR (P=0.12) and CBF (P<0.05), an effect attributable to defective early diastolic CBF acceleration (P<0.05) and associated with greater ST‐segment depression (P<0.05).ConclusionsIn patients with obstructive coronary stenoses, cold air inhalation causes deleterious changes in MVR and CBF. These diminish or abolish the normal adaptations during exertion that ordinarily match myocardial blood supply to demand.

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“…1-3 A substantial number of STEMI patients are also found to have significant stenosis in non-culprit vessels during primary PCI. [4][5][6][7] The optimal strategy for the management of these lesions has not been well established. 1,2,[8][9][10] Two recent randomized controlled trials have demonstrated improved outcomes with multivessel revascularization in STEMI patients with multivessel disease.…”

Section: Introductionmentioning

confidence: 99%

Safety and Efficacy of Staged Percutaneous Coronary Intervention During Index Admission for ST-Elevation Myocardial Infarction With Multivessel Coronary Disease (Insights from the University of Ottawa Heart Institute STEMI Registry)

Russo

Wells

Chong

et al. 2015

The American Journal of Cardiology

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Extent, Location, and Clinical Significance of Non–Infarct-Related Coronary Artery Disease Among Patients With ST-Elevation Myocardial Infarction

Cited by 308 publications

References 32 publications

Staged Percutaneous Intervention for Concurrent Chronic Total Occlusions in Patients With ST‐Segment–Elevation Myocardial Infarction: A Systematic Review and Meta‐Analysis

Staged Percutaneous Intervention for Concurrent Chronic Total Occlusions in Patients With ST‐Segment–Elevation Myocardial Infarction: A Systematic Review and Meta‐Analysis

Deleterious Effects of Cold Air Inhalation on Coronary Physiological Indices in Patients With Obstructive Coronary Artery Disease

Safety and Efficacy of Staged Percutaneous Coronary Intervention During Index Admission for ST-Elevation Myocardial Infarction With Multivessel Coronary Disease (Insights from the University of Ottawa Heart Institute STEMI Registry)

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