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

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Abstract

Background

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).

Methods

A total of 226 patients (182 men, age 65 ± 10 years) 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 ± 3 months and 60 ± 10 months after presentation. CP was defined as an increase in stenosis severity >15% of a nonculprit lesion between 2 serial CAGs.

Results

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 <60 ml/min/1.73 m2 (odds ratio 2.447, P = 0.015), and diabetes mellitus (odds ratio 2.135, P = 0.021).

Conclusions

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.

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Abbreviations

CP:

Coronary artery disease progression

CAD:

Coronary artery disease

eGFR:

Estimated glomerular filtration rate

NSTEACS:

Non-ST-segment elevation acute coronary syndrome

SAP:

Stable angina pectoris

STEACS:

ST-segment elevation acute coronary syndrome

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Authors and Affiliations

  1. Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, 6-16-1 Tomioka-higashi, Kanazawa-ku, Yokohama, Kanagawa, 236-8651, Japan

    Tatsuya Nakachi, Naoki Iinuma, Hidekuni Kirigaya, Shingo Kato & Kazuki Fukui

  2. Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan

    Masami Kosuge & Kazuo Kimura

Authors
  1. Tatsuya Nakachi
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  2. Masami Kosuge
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  3. Naoki Iinuma
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  4. Hidekuni Kirigaya
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  5. Shingo Kato
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  6. Kazuki Fukui
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  7. Kazuo Kimura
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Corresponding author

Correspondence to Tatsuya Nakachi.

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Conflict of interest

Tatsuya Nakachi, MD: None. Masami Kosuge, MD: None. Naoki Iinuma, MD: None. HidekuniKirigaya, MD: None. Shingo Kato, MD, PhD: Scholarship from the Banyu Life Science Foundation International. Kazuki Fukui, MD: None. Kazuo Kimura, MD, PhD: Research support or honoraria or both from Astellas Pharma, Inc., AstraZeneca K.K., Bayer Yakuhin, Ltd., BoehringerIngelheim Japan, Inc., Daiichi-Sankyou Company, Eli Lilly Japan K.K., Kowa Company, Ltd., MSD K.K., Ono Pharmaceutical Co., Ltd., Otsuka Pharmaceutical Co., Ltd., Pfizer Japan Inc. Research Institute for Production Development, Sanofi K.K., Takeda Pharmaceutical Company, Shionogi & Co. Ltd., Mitsubishi Tanabe Pharma Corporation, Toa Eiyo Ltd.

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Nakachi, T., Kosuge, M., Iinuma, N. et al. ST-segment category at acute presentation is associated with the time course of coronary artery disease progression in patients with acute coronary syndromes. Heart Vessels 32, 644–652 (2017). https://doi.org/10.1007/s00380-016-0917-8

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  • DOI: https://doi.org/10.1007/s00380-016-0917-8

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