Frequency, Etiology, and Impact of Unplanned Repeat Coronary Angiography After ST-Elevation Myocardial Infarction.
Aged
Coronary Angiography
/ statistics & numerical data
Coronary Thrombosis
/ epidemiology
Drug-Eluting Stents
Female
Hospital Mortality
Humans
Male
Middle Aged
Percutaneous Coronary Intervention
/ methods
Platelet Aggregation Inhibitors
/ therapeutic use
Postoperative Complications
/ epidemiology
Postoperative Hemorrhage
/ epidemiology
Recurrence
ST Elevation Myocardial Infarction
/ complications
Shock, Cardiogenic
/ epidemiology
Stents
Stroke Volume
/ physiology
Troponin
/ blood
Vascular Patency
Journal
The American journal of cardiology
ISSN: 1879-1913
Titre abrégé: Am J Cardiol
Pays: United States
ID NLM: 0207277
Informations de publication
Date de publication:
15 01 2022
15 01 2022
Historique:
received:
19
08
2021
revised:
20
09
2021
accepted:
24
09
2021
pubmed:
24
11
2021
medline:
1
2
2022
entrez:
23
11
2021
Statut:
ppublish
Résumé
Unplanned repeat coronary angiography (CAG) after balloon angioplasty for ST-elevation myocardial infarction (STEMI) was common before the advent of coronary stenting. Limited data are available regarding the role of unplanned repeat CAG in contemporary percutaneous coronary intervention (PCI) for STEMI. Therefore, we analyzed a large, 2-center prospective STEMI registry (January 2011 to June 2020) stratified by the presence or absence of unplanned repeat CAG during index hospitalization. Patients with planned CAG for staged PCI or experimental drug administration were excluded. Among 3,637 patients with STEMI, 130 underwent unplanned repeat CAG (3.6%) during index hospitalization. These patients were more likely to have cardiogenic shock (16% vs 9.8%, p = 0.021), left anterior descending culprit (44% vs 31%, p <0.001), lower left ventricular ejection fraction (45% vs 52%, p <0.001), and higher peak troponin levels (22 vs 8 ng/ml, p <0.001) than those without repeat CAG. At repeat CAG, 80 patients had a patent stent (62%) including 65 requiring no further intervention (50%) and 15 who underwent intervention on a nonculprit lesion (12%). Only 32 patients had stent thrombosis (25%). Repeat CAG was associated with a higher incidence of recurrent MI (19% vs 0%, p <0.001) and major bleeding (12% vs 4.5%, p <0.001), yet similar in-hospital mortality (7% vs 6.4%, p = 0.93) than those without repeat CAG. In conclusion, in the era of contemporary PCI for STEMI, unplanned repeat CAG during index hospitalization was infrequent and more commonly observed in patients with left anterior descending culprit in the presence of significant left ventricular dysfunction or shock and was associated with higher in-hospital recurrent myocardial infarction and major bleeding complications.
Identifiants
pubmed: 34809859
pii: S0002-9149(21)00995-4
doi: 10.1016/j.amjcard.2021.09.038
pii:
doi:
Substances chimiques
Platelet Aggregation Inhibitors
0
Troponin
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1-7Informations de copyright
Copyright © 2021. Published by Elsevier Inc.
Déclaration de conflit d'intérêts
Disclosures The authors have no conflicts of interest to declare.