Angiographic morphology impacts outcomes in STEMI patients with LAD occlusion

Abstract

Acute proximal occlusion of the left anterior descendent coronary artery (LAD) is a critical medical condition often leading to heart failure and death. Our objective was to investigate how additional angiographic findings might influence prognosis. In a single center setting by using consecutive data from the Swedish angiography and angioplasty registry (SCAAR), we identified all patients with acute myocardial infarction (AMI) related to the proximal LAD referred for primary coronary angioplasty. Clinical and angiographic data were collected from January 2004 to December 2008. In the study period, 359 patients (mean age 67.9 ± 12.3 years, 111 women) were identified as having proximal LAD-related culprit lesion. Follow-up was up to 5.5 years. Compared to patients with LAD occlusion only, having both a small conus branch (<0.5 mm in diameter) and an occluded first septal perforator was associated with increased risk of death after adjustment for age, diabetes mellitus and prior AMI (hazard ratio 4.5, 95% CI; 1.1-18, P = 0.033). A small conus branch in itself was not important. Multivessel coronary artery disease in addition to occlusion of the first septal perforator branch and having a small conus branch was also associated with increased risk of death (hazard ratio 5.2, 95% CI; 1.3-20), P = 0.018). In patients with STEMI because of a proximal LAD lesion treated by primary PCI, the combination of a small conus branch and an occluded first septal perforator branch is associated with a poorer outcome. Additional presence of multivessel coronary artery disease further aggravates outcome.