TY - JOUR
T1 - Impact of nonculprit vessel myocardial perfusion on outcomes of patients undergoing percutaneous coronary intervention for acute coronary syndromes
T2 - Analysis from the ACUITY trial (Acute Catheterization and Urgent Intervention Triage Strategy)
AU - Lansky, Alexandra J.
AU - Ng, Vivian G.
AU - Meller, Stephanie
AU - Xu, Ke
AU - Fahy, Martin
AU - Feit, Frederick
AU - Ohman, E. Magnus
AU - White, Harvey D.
AU - Mehran, Roxana
AU - Bertrand, Michel E.
AU - Desmet, Walter
AU - Hamon, Martial
AU - Stone, Gregg W.
N1 - Funding Information:
The ACUITY trial was sponsored and funded by The Medicines Company and Nycomed . Dr. Feit has received consulting fees from The Medicines Company; and is a shareholder in Boston Scientific, Johnson & Johnson, Medtronic, and The Medicines Company. Dr. Ohman has received grant support from Daiichi Sankyo, Eli Lilly, and Gilead Sciences ; has received consulting fees from Abiomed, AstraZeneca, Biotie, Ikaria, Ivivi, Janssen, Liposcience, Pozen, Sanofi-Aventis, The Medicines Company, and WebMD; and has served on the Speakers’ Bureaus of Gilead Sciences and Liposcience. Dr. White has unrestricted research grant support from AstraZeneca, Merck Sharp & Dohme, Roche, Regado Biosciences, Sanofi-Aventis, Eli Lilly, The Medicines Company, the National Institutes of Health, GlaxoSmithKline, and Daiichi Sankyo . Dr. Mehran has received institutional research grant support from The Medicines Company, Bristol-Myers Squibb/sanofi, and Lilly/Daichii Sankyo ; and has received consulting fees from Abbott Vascular, AstraZeneca, Boston Scientific, Covidien, Janssen (Johnson & Johnson), Regado Biosciences, Maya Medical, and Merck & Co. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
PY - 2014/3
Y1 - 2014/3
N2 - Objectives: This study evaluated the impact of nonculprit vessel myocardial perfusion on outcomes of non-ST-segment elevation acute coronary syndromes (NSTE-ACS) patients. Background: ST-segment elevation myocardial infarction patients have decreased perfusion in areas remote from the infarct-related vessel. The impact of myocardial hypoperfusion of regions supplied by nonculprit vessels in NSTE-ACS patients treated with percutaneous coronary intervention (PCI) is unknown. Methods: The angiographic substudy of the ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy) trial included 6,921 NSTE-ACS patients. Complete 3-vessel assessments of baseline coronary TIMI (Thrombolysis In Myocardial Infarction) flow grade and myocardial blush grade (MBG) were performed. We examined the outcomes of PCI-treated patients according to the worst nonculprit vessel MBG identified per patient. Results: Among the 3,826 patients treated with PCI, the worst nonculprit MBG was determined in 3,426 (89.5%) patients, including 375 (10.9%) MBG 0/1 patients, 475 (13.9%) MBG 2 patients, and 2,576 (75.2%) MBG 3 patients. Nonculprit MBG 0/1 was associated with worse baseline clinical characteristics. Patients with nonculprit MBG 0/1 versus MBG 3 had increased rates of 30-day (3.0% vs. 0.7%, p < 0.0001) and 1-year (4.4% vs. 1.0%, p < 0.0001) death. Similar results were found among patients with pre-procedural TIMI flow grade 3 in the culprit vessel, where nonculprit vessel MBG 0/1 (hazard ratio: 2.81 [95% confidence interval: 1.63 to 4.84], p = 0.0002) was the strongest predictor of 1-year mortality. Conclusions: Reduced myocardial perfusion in an area supplied by a nonculprit vessel is associated with increased short- and long-term mortality rates in NSTE-ACS patients undergoing PCI. Furthermore, worst nonculprit MBG is able to risk-stratify patients with normal baseline flow of the culprit vessel.
AB - Objectives: This study evaluated the impact of nonculprit vessel myocardial perfusion on outcomes of non-ST-segment elevation acute coronary syndromes (NSTE-ACS) patients. Background: ST-segment elevation myocardial infarction patients have decreased perfusion in areas remote from the infarct-related vessel. The impact of myocardial hypoperfusion of regions supplied by nonculprit vessels in NSTE-ACS patients treated with percutaneous coronary intervention (PCI) is unknown. Methods: The angiographic substudy of the ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy) trial included 6,921 NSTE-ACS patients. Complete 3-vessel assessments of baseline coronary TIMI (Thrombolysis In Myocardial Infarction) flow grade and myocardial blush grade (MBG) were performed. We examined the outcomes of PCI-treated patients according to the worst nonculprit vessel MBG identified per patient. Results: Among the 3,826 patients treated with PCI, the worst nonculprit MBG was determined in 3,426 (89.5%) patients, including 375 (10.9%) MBG 0/1 patients, 475 (13.9%) MBG 2 patients, and 2,576 (75.2%) MBG 3 patients. Nonculprit MBG 0/1 was associated with worse baseline clinical characteristics. Patients with nonculprit MBG 0/1 versus MBG 3 had increased rates of 30-day (3.0% vs. 0.7%, p < 0.0001) and 1-year (4.4% vs. 1.0%, p < 0.0001) death. Similar results were found among patients with pre-procedural TIMI flow grade 3 in the culprit vessel, where nonculprit vessel MBG 0/1 (hazard ratio: 2.81 [95% confidence interval: 1.63 to 4.84], p = 0.0002) was the strongest predictor of 1-year mortality. Conclusions: Reduced myocardial perfusion in an area supplied by a nonculprit vessel is associated with increased short- and long-term mortality rates in NSTE-ACS patients undergoing PCI. Furthermore, worst nonculprit MBG is able to risk-stratify patients with normal baseline flow of the culprit vessel.
KW - acute coronary syndrome
KW - epicardial flow
KW - mortality
KW - myocardial perfusion
KW - non-culprit vessel
KW - percutaneous coronary intervention
UR - https://www.scopus.com/pages/publications/84896521736
U2 - 10.1016/j.jcin.2013.08.016
DO - 10.1016/j.jcin.2013.08.016
M3 - Article
C2 - 24650400
AN - SCOPUS:84896521736
SN - 1936-8798
VL - 7
SP - 266
EP - 275
JO - JACC: Cardiovascular Interventions
JF - JACC: Cardiovascular Interventions
IS - 3
ER -