ST-segment category at acute presentation is associated with the time course of coronary artery disease progression in patients with acute coronary syndromes.

Abstract

Several studies have shown higher early mortality for ST-segment elevation acute coronary syndrome (STEACS), but late mortality remains consistently higher for non-ST-segment elevation acute coronary syndrome (NSTEACS). We hypothesized that ST-segment category at acute presentation is associated with the time course of coronary artery disease progression (CP) of nonculprit lesions in patients with acute coronary syndrome (ACS). A total of 226 patients (182 men, age 65±10years) with STEACS (n=95) or NSTEACS (n=131) who underwent percutaneous coronary intervention (PCI) during initial hospitalization were studied. All patients underwent serial coronary angiograms (CAGs) performed immediately before PCI and at 7±3months and 60±10months after presentation. CP was defined as an increase in stenosis severity >15% of a nonculprit lesion between 2 serial CAGs. The rate of CP between the first and second CAGs did not differ by ST-segment category at acute presentation. Compared to STEACS, NSTEACS had a higher rate of CP between the second and final CAGs (27.4 vs. 42.7%, P=0.018). Multivariate analysis showed that the independent predictors of CP between the second and final CAGs were NSTEACS (odds ratio 2.709, P=0.003), estimated glomerular filtration rate <60ml/min/1.73m2 (odds ratio 2.447, P=0.015), and diabetes mellitus (odds ratio 2.135, P=0.021). Irrespective of conventional risk factors and angiographic findings, ST-segment category at initial presentation is associated with the persistency of widespread coronary disease activity following presentation in ACS patients undergoing PCI. This may partly explain the time-dependent differences in outcomes of patients with STEACS and NSTEACS.