Abstract
The purpose of this study was to assess the incidence, predictors, and presentation of target vessel failure (TVF) after primary stenting for ST-segment elevation myocardial infarction (MI) as opposed to elective stenting. A total of 8237 consecutive patients undergoing urgent or elective percutaneous coronary intervention (PCI) were enrolled in our database and followed for a median of 1234 days (interquartile range 782-1688 days). Any acute ischemic event attributed to the obstruction of the stented vessel was considered as TVF. Stent thrombosis was classified according to the Academic Research Consortium, whereas restenosis and new culprit lesion were defined as obstructions within or outside stent boundaries, respectively. Unstable clinical presentation required urgent hospital admission or caused unexplained sudden death. Multivariable analyses were performed with Cox proportional hazards regression models. TVF occurred in 4.2% of our population. A measurable proportion of patients had to be re-admitted to hospital: 1.6% because of stent thrombosis, 1.5% because of restenosis, and 0.3% because of new culprit lesion. Ten (0.1%) patients were found victims of sudden death. De-novo lesions showed less TVF [hazard ratio (HR) 0.22, 95% confidence interval (CI) 0.16-0.30, P < 0.0001]. Primary PCI was associated with increased risk of TVF (HR 1.83, 95% CI 1.43-2.36, P < 0.0001), stent thrombosis (HR 2.59, 95% CI 1.80-3.72, P < 0.0001), and MI (HR 2.16, 95% CI 1.61-2.91, P < 0.0001). The events appeared earlier after primary PCI with more than 50% within the first month; after the first year, further occurrences were similar in both groups. Finally, the use of everolimus-eluting stents suggested the best safety profile. The present study shows that acute ischemic events are frequent after primary PCI and occur earlier compared with elective PCI. Particular attention should be directed towards optimal stent selection and implantation technique.
Published Version
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