46 Management of non-culprit disease in ST elevation myocardial infarction patients: a three year Irish tertiary referral centre experience

BackgroundRecent large scale clinical trials have demonstrated benefit of revascularisation of nonculprit lesions in patients presenting with ST elevation myocardial infarction (STEMI) in terms of reduction in myocardial infarction and cardiovascular death. In the COMPLETE trial, a relative risk reduction of 26% of the coprimary endpoint of death or MI was observed. Anecdotally, complete revascularisation is not achieved in a significant number of patients presenting with STEMI with nonculprit disease.PurposeOur study aimed to retrospectively evaluate clinical practice at our centre in terms of management and outcomes of patients presenting with STEMI and angiographically significant nonculprit coronary disease.MethodsA retrospective evaluation was undertaken of the clinical records of all patients presenting to our centre with STEMI from 2019–2021 who had at least one nonculprit coronary lesion judged to be significant by angiographic assessment by the operating interventional cardiologist. Baseline demographics, readmission rates, mortality data as inpatient and at one year were collected and analysed. For those patients whom were offered further percutaneous coronary intervention (PCI) for complete revascularisation, data surrounding timing of PCI was collected.ResultsOver a 3-year period, 217 patients presenting with STEMI had nonculprit coronary disease with a mean age of 63.5+/-11.3 years; 78.3% were male. 123 patients (56.7%) underwent revascularisation either via PCI (n=96) or coronary bypass grafting (n=27). A total of 66 patients were managed with optimal medical therapy (OMT); 23 had negative functional testing by FFR with 43 assigned to OMT as primary strategy. 18 patients died prior to strategy determination, and 10 patients were lost to follow-up. Patients assigned to primary OMT were significantly older with mean age of 69.8+/-9.4 years (p=0.006) (figure 2). Our cohort had a 1-month mortality of 8.3% and a 1 year mortality of 12.0%. Of those managed with PCI, 77.1% (n=74) took place as elective outpatient PCI, with a mean time to PCI of 57.8 days from index presentation; median was lower at 36.5 days reflecting a positive skew (figure 1). Further analysis showed significant delays when 2019 was compared to 2020–21; this likely reflected the impact of COVID-19 in terms of deleterious impacts on outpatient waiting lists, list cancellations, restructuring of services due to reallocation of staff, and curtailed delivery of procedures during the