Association of lesion complexity following fibrinolytic administration with mortality in ST-elevation myocardial infarction

Greater lesion complexity, according to the American College of Cardiology and American Heart Association, has been associated with decreased success rates of percutaneous coronary intervention. We hypothesized that greater lesion complexity after fibrinolytic administration for ST-segment elevation myocardial infarction would similarly be associated with increased mortality and other adverse events at 30 days. We studies 2,605 patients from the Thrombolysis In Myocardial Infarction 10B and 14, Integrilin and Tenecteplase in Acute Myocardial Infarction, ENTIRE, and FASTER studies. For all studies, angiographic outcomes were assessed immediately after fibrinolytic administration and clinical outcomes were assessed at 30 days. Greater lesion complexity was associated with poorer epicardial flow and decreased myocardial perfusion at 60 minutes and after percutaneous coronary intervention and with a higher risk of shock and mortality within 30 days. In a multivariate model, type C lesion complexity remained associated with an increased 30-day mortality rate.