Impact of left anterior descending artery involvement in non-anterior ST elevated myocardial infarction

Background:
ST elevated myocardial infarction (STEMI) has worst outcome when presenting with multi-vessel disease (MVD). When left anterior descending artery (LAD) is the non-infarct related artery (IRA) in non-anterior wall STEMI, it´s treatment depends con anatomical complexity, operator decision or ischemia driven. Objective: To analyze both clinical and procedural results of patients (pts) with non-anterior STEMI and MVD, according to the involvement of LAD as non IRA, either at the procedure and in extra-hospital follow up.

Methods:
From 2001 to December 2018 495 PCI in STEMI were done, excluding prior CABG, epiphenomenon and Killip class D. 214 were anterior wall STEMI and 281 non anterior. Of these last pts, 152 had MVD. According to the involvement of LAD as non-IRA, two groups were conformed. Group A (without LAD) n=59 and Group B (with LAD) n=93 pts. Baseline characteristics were Group A vs Group B n (%) respectively: Age 59.8±9.4 vs 60.6±11.7; male 54(92) vs 82(88); diabetics 11(19) vs 22(24); prior AMI 3(5) vs 10(11); prior PCI 11(19) vs 7(8) p=0.03; EF 55.2±10.7 vs 55.3±15.2; Killip class A 51(86) vs 79(85); class B; 8(14) vs 8(9); class C 0 vs 6(6) p=0.04; IIbIIIa 7(12) vs 16(17); DTB (min) 98±52 vs 104±59; 2 vessel 50(85) vs 61(66) p=0.01; 3 vessel 9(15) vs 32(34) p=0.01; complete revascularization (CR) 44(75) vs 46(49) p<0.01; same session CR 25(42) vs 21(23) p=0.01; RCA IRA 29(49) vs 64(69) p=0.01; LCX IRA 30(51) vs 29(31) p=0.01; initial TIMI 0/1 40(68) vs 66(71); stent mm 48.3±27.3 vs 48±30.3; radial 33(56) vs 31(33) p<0.01; thromboaspiration 4(7) vs 5(5); fluoro (min) 15±13.8 vs 18.9vs13.3 p=0.08; contrast (ml) 209.1±83.3 vs 244.2±89.6 p=0.01

Results:
Group A vs Group B n (%) respectively: Clinical success 57(97) vs 87(94); in hospital (IH) cardiac death 0 vs 4(4) p=0.1; early coronary occlussion 3(5) vs 0 p=0.05; stroke 0 vs 1(1); vascular complication 0 vs 1(1); mean follow up 43.8±34.3 vs 41.3±31.1; extra hospital (EH) cardiac death 0 vs 3(3) p=0.1; reintervention 8(14) vs 18(19) p=0.3; TLR 2(3) vs 4(4); de novo PCI 4(7) vs 10(11); CABG 2(3) vs 4(4); IH&EH cardiac death at 2 years 0 vs 6(6) p=0.08

Conclusions:
In pts with non-anterior STEMI, MVD and LAD as non-IRA, we found greater cardiovascular death at two years follow up.