Impact of Multiple Complex Plaques on Short- and Long-Term Clinical Outcomes in Patients Presenting With ST-Segment Elevation Myocardial Infarction (from the Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction [HORIZONS-AMI] Trial)
It is not known whether the extent and severity of nonculprit coronary lesions correlate with outcomes in patients with ST-segment elevation myocardial infarction (STEMI) referred for primary percutaneous coronary intervention (PCI). We sought to quantify complex plaques in patients with STEMI refer...
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| Veröffentlicht in: | The American journal of cardiology 2014-05, Vol.113 (10), p.1621-1627 |
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| creator | Keeley, Ellen C., MD, MS Mehran, Roxana, MD Brener, Sorin J., MD Witzenbichler, Bernhard, MD Guagliumi, Giulio, MD Dudek, Dariusz, MD Kornowski, Ran, MD Dressler, Ovidiu, MD Fahy, Martin, MSc Xu, Ke, PhD Grines, Cindy L., MD Stone, Gregg W., MD |
| description | It is not known whether the extent and severity of nonculprit coronary lesions correlate with outcomes in patients with ST-segment elevation myocardial infarction (STEMI) referred for primary percutaneous coronary intervention (PCI). We sought to quantify complex plaques in patients with STEMI referred for primary PCI and to determine their effect on short- and long-term clinical outcomes by examining the core laboratory database for plaque analysis from the Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction study. Baseline demographic, angiographic, and procedural details were compared between patients with single versus multiple complex plaques who underwent single-vessel PCI. Multivariable analysis was performed for predictors of long-term major adverse cardiac events (MACEs), a combined end point of death, reinfarction, ischemic target-vessel revascularization, or stroke, and for death alone. Single-vessel PCI was performed in 3,137 patients (87%): 2,174 (69%) had multiple complex plaques and 963 (31%) had a single complex plaque. Compared with those with a single complex plaque, patients with multiple complex plaques were older (p |
| doi_str_mv | 10.1016/j.amjcard.2014.02.016 |
| format | Article |
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We sought to quantify complex plaques in patients with STEMI referred for primary PCI and to determine their effect on short- and long-term clinical outcomes by examining the core laboratory database for plaque analysis from the Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction study. Baseline demographic, angiographic, and procedural details were compared between patients with single versus multiple complex plaques who underwent single-vessel PCI. Multivariable analysis was performed for predictors of long-term major adverse cardiac events (MACEs), a combined end point of death, reinfarction, ischemic target-vessel revascularization, or stroke, and for death alone. Single-vessel PCI was performed in 3,137 patients (87%): 2,174 (69%) had multiple complex plaques and 963 (31%) had a single complex plaque. Compared with those with a single complex plaque, patients with multiple complex plaques were older (p <0.0001) and had more co-morbidities. The presence of multiple complex plaques was an independent predictor of 3-year MACE (hazard ratio 1.58, 95% confidence interval 1.26 to 1.98, p <0.0001), and death alone (hazard ratio 1.68, 95% confidence interval 1.05 to 2.70, p = 0.03). In conclusion, multiple complex plaques are present in the majority of patients with STEMI who underwent primary PCI, and their presence is an independent predictor of short- and long-term MACE, including death (Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction; NCT00433966 ).</description><identifier>ISSN: 0002-9149</identifier><identifier>EISSN: 1879-1913</identifier><identifier>DOI: 10.1016/j.amjcard.2014.02.016</identifier><identifier>PMID: 24703369</identifier><identifier>CODEN: AJCDAG</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Aged ; Cardiology ; Cardiovascular ; Clinical outcomes ; Coronary Angiography ; Coronary vessels ; Drug-Eluting Stents ; Electrocardiography ; Female ; Follow-Up Studies ; Heart attacks ; Humans ; Male ; Middle Aged ; Myocardial Infarction - epidemiology ; Myocardial Infarction - etiology ; Myocardial Infarction - surgery ; Percutaneous Coronary Intervention - methods ; Plaque, Atherosclerotic - complications ; Plaque, Atherosclerotic - diagnosis ; Plaque, Atherosclerotic - surgery ; Prognosis ; Stents ; Survival Rate - trends ; Time Factors ; Treatment Outcome ; United States - epidemiology</subject><ispartof>The American journal of cardiology, 2014-05, Vol.113 (10), p.1621-1627</ispartof><rights>Elsevier Inc.</rights><rights>2014 Elsevier Inc.</rights><rights>Copyright © 2014 Elsevier Inc. All rights reserved.</rights><rights>Copyright Elsevier Limited May 15, 2014</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c495t-9c5bf7a50b28f3e6791e0aa27b86bc8b9331e485352b51d585f8797d731d6e1c3</citedby><cites>FETCH-LOGICAL-c495t-9c5bf7a50b28f3e6791e0aa27b86bc8b9331e485352b51d585f8797d731d6e1c3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0002914914007085$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24703369$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Keeley, Ellen C., MD, MS</creatorcontrib><creatorcontrib>Mehran, Roxana, MD</creatorcontrib><creatorcontrib>Brener, Sorin J., MD</creatorcontrib><creatorcontrib>Witzenbichler, Bernhard, MD</creatorcontrib><creatorcontrib>Guagliumi, Giulio, MD</creatorcontrib><creatorcontrib>Dudek, Dariusz, MD</creatorcontrib><creatorcontrib>Kornowski, Ran, MD</creatorcontrib><creatorcontrib>Dressler, Ovidiu, MD</creatorcontrib><creatorcontrib>Fahy, Martin, MSc</creatorcontrib><creatorcontrib>Xu, Ke, PhD</creatorcontrib><creatorcontrib>Grines, Cindy L., MD</creatorcontrib><creatorcontrib>Stone, Gregg W., MD</creatorcontrib><title>Impact of Multiple Complex Plaques on Short- and Long-Term Clinical Outcomes in Patients Presenting With ST-Segment Elevation Myocardial Infarction (from the Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction [HORIZONS-AMI] Trial)</title><title>The American journal of cardiology</title><addtitle>Am J Cardiol</addtitle><description>It is not known whether the extent and severity of nonculprit coronary lesions correlate with outcomes in patients with ST-segment elevation myocardial infarction (STEMI) referred for primary percutaneous coronary intervention (PCI). We sought to quantify complex plaques in patients with STEMI referred for primary PCI and to determine their effect on short- and long-term clinical outcomes by examining the core laboratory database for plaque analysis from the Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction study. Baseline demographic, angiographic, and procedural details were compared between patients with single versus multiple complex plaques who underwent single-vessel PCI. Multivariable analysis was performed for predictors of long-term major adverse cardiac events (MACEs), a combined end point of death, reinfarction, ischemic target-vessel revascularization, or stroke, and for death alone. Single-vessel PCI was performed in 3,137 patients (87%): 2,174 (69%) had multiple complex plaques and 963 (31%) had a single complex plaque. Compared with those with a single complex plaque, patients with multiple complex plaques were older (p <0.0001) and had more co-morbidities. The presence of multiple complex plaques was an independent predictor of 3-year MACE (hazard ratio 1.58, 95% confidence interval 1.26 to 1.98, p <0.0001), and death alone (hazard ratio 1.68, 95% confidence interval 1.05 to 2.70, p = 0.03). 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Academic</collection><jtitle>The American journal of cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Keeley, Ellen C., MD, MS</au><au>Mehran, Roxana, MD</au><au>Brener, Sorin J., MD</au><au>Witzenbichler, Bernhard, MD</au><au>Guagliumi, Giulio, MD</au><au>Dudek, Dariusz, MD</au><au>Kornowski, Ran, MD</au><au>Dressler, Ovidiu, MD</au><au>Fahy, Martin, MSc</au><au>Xu, Ke, PhD</au><au>Grines, Cindy L., MD</au><au>Stone, Gregg W., MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Impact of Multiple Complex Plaques on Short- and Long-Term Clinical Outcomes in Patients Presenting With ST-Segment Elevation Myocardial Infarction (from the Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction [HORIZONS-AMI] Trial)</atitle><jtitle>The American journal of cardiology</jtitle><addtitle>Am J Cardiol</addtitle><date>2014-05-15</date><risdate>2014</risdate><volume>113</volume><issue>10</issue><spage>1621</spage><epage>1627</epage><pages>1621-1627</pages><issn>0002-9149</issn><eissn>1879-1913</eissn><coden>AJCDAG</coden><abstract>It is not known whether the extent and severity of nonculprit coronary lesions correlate with outcomes in patients with ST-segment elevation myocardial infarction (STEMI) referred for primary percutaneous coronary intervention (PCI). We sought to quantify complex plaques in patients with STEMI referred for primary PCI and to determine their effect on short- and long-term clinical outcomes by examining the core laboratory database for plaque analysis from the Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction study. Baseline demographic, angiographic, and procedural details were compared between patients with single versus multiple complex plaques who underwent single-vessel PCI. Multivariable analysis was performed for predictors of long-term major adverse cardiac events (MACEs), a combined end point of death, reinfarction, ischemic target-vessel revascularization, or stroke, and for death alone. Single-vessel PCI was performed in 3,137 patients (87%): 2,174 (69%) had multiple complex plaques and 963 (31%) had a single complex plaque. Compared with those with a single complex plaque, patients with multiple complex plaques were older (p <0.0001) and had more co-morbidities. The presence of multiple complex plaques was an independent predictor of 3-year MACE (hazard ratio 1.58, 95% confidence interval 1.26 to 1.98, p <0.0001), and death alone (hazard ratio 1.68, 95% confidence interval 1.05 to 2.70, p = 0.03). In conclusion, multiple complex plaques are present in the majority of patients with STEMI who underwent primary PCI, and their presence is an independent predictor of short- and long-term MACE, including death (Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction; NCT00433966 ).</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>24703369</pmid><doi>10.1016/j.amjcard.2014.02.016</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | The American journal of cardiology, 2014-05, Vol.113 (10), p.1621-1627 |
| issn | 0002-9149 1879-1913 |
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| source | MEDLINE; Elsevier ScienceDirect Journals |
| subjects | Aged Cardiology Cardiovascular Clinical outcomes Coronary Angiography Coronary vessels Drug-Eluting Stents Electrocardiography Female Follow-Up Studies Heart attacks Humans Male Middle Aged Myocardial Infarction - epidemiology Myocardial Infarction - etiology Myocardial Infarction - surgery Percutaneous Coronary Intervention - methods Plaque, Atherosclerotic - complications Plaque, Atherosclerotic - diagnosis Plaque, Atherosclerotic - surgery Prognosis Stents Survival Rate - trends Time Factors Treatment Outcome United States - epidemiology |
| title | Impact of Multiple Complex Plaques on Short- and Long-Term Clinical Outcomes in Patients Presenting With ST-Segment Elevation Myocardial Infarction (from the Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction [HORIZONS-AMI] Trial) |
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