Abstract 9297: ST-Segment Category at Acute Presentation is Associated with Time Course of Coronary Artery Disease Progression in Patients with Acute Coronary Syndromes

Abstract

Background: Acute coronary syndrome (ACS) is categorized, according to the presenting electrocardiogram, into ST-segment elevation ACS (STEACS) and non-ST-segment elevation ACS (NSTEACS). Several studies have shown that early mortality was higher for STEACS, but late mortality remained consistently higher for NSTEACS. However, its underlying mechanism is unclear. Methods: We studied 219 patients (179 men, age 64 + 10 years) with STEACS (n= 93) or NSTEACS (n = 126) who underwent percutaneous coronary intervention (PCI) for culprit lesion during initial hospitalization. Estimated glomerular filtration rate (eGFR) was calculated according to MDRD study formula at initial presentation. All patients underwent serial coronary angiograms (CAGs) performed immediately before PCI ,and at 6 + 3 months and 60 + 10 months after presentation. Coronary artery disease progression (CP) was defined as an increase > 15 % in stenosis severity of lesion in nonculprit artery between 2 serial CAGs. Results: There were no significant differences in age, sex, coronary risk factors, lipid profiles, eGFR, multivessel disease, follow-up periods and medication between STEACS and NSTEACS. The rate of CP between first and second CAGs did not differ according to ST-segment category at acute presentation. Compared to STEACS, NSTEACS had higher rate of CP between second and final CAGs (Figure). Multivariate analysis revealed that the independent predictors of CP between second and final CAGs were NSTEACS (odds ratio 3.01, 95% CI 1.52 to 5.94, p=0.002), eGFR < 60 ml/min/1.73m 2 (odds ratio 2.32, 95% CI 1.11 to 4.84, p=0.025) , and diabetes mellitus (odds ratio 2.18, 95% CI 1.12 to 4.21, p=0.021). Conclusion: ST-segment category at initial presentation is associated with the persistency of the widespread coronary disease activity following presentation in patients with ACS undergoing PCI. This may partly explain the time-dependent differences in outcomes among patients with STEACS and NSTEACS.