Abstract 352: Does Imaging The Culprit or Non-culprit Coronary Artery First in Acute ST-Elevation Myocardial Infarction Change Outcomes?
Abstract only Background: Practice variation exists regarding diagnostic coronary angiography for acute ST elevation myocardial infarction (STEMI). Operators can initially image either the presumed culprit vessel (CV) or the non-culprit vessel (NCV) based on the electrocardiogram (ECG) injury patter...
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| Published in: | Circulation Cardiovascular quality and outcomes Vol. 8; no. suppl_2 |
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| Main Authors: | , , , , |
| Format: | Journal Article |
| Language: | English |
| Published: |
01-05-2015
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| Online Access: | Get full text |
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| Summary: | Abstract only
Background:
Practice variation exists regarding diagnostic coronary angiography for acute ST elevation myocardial infarction (STEMI). Operators can initially image either the presumed culprit vessel (CV) or the non-culprit vessel (NCV) based on the electrocardiogram (ECG) injury pattern. It is not clear if this leads to clinically meaningful differences in the time to intervention or outcomes.
Methods:
All patients presenting to the University of Wisconsin for STEMI (2009 to 2013) and registered with the National Cardiovascular Data Registry (NCDR) were included. Baseline ECGs were reviewed to identify the probable culprit vessel. Coronary angiograms were reviewed and subjects were divided into CV or NCV groups based on the artery imaged first. Differences between groups were compared with student’s t-tests of unequal variance. CV and NCV effect on death was analyzed with logistical regression models adjusted for age, sex, cardiovascular disease risk factors, access site, peak troponin, and time to intervention time.
Results:
The 702 STEMI patients identified were mean (standard deviation) 62.7 (13.2) years old and 28% (195 of 702) female. The left coronary artery was the presumed culprit vessel in 46% of cases; the right coronary artery was the presumed culprit in 54% of cases. The CV was imaged first in 28.5% (200 of 702) of cases and the NCV was imaged first in 71.7% (502 of 702) of the cases. Of these, 610 (87%) underwent primary percutaneous coronary intervention (PCI); 40 (5.6%) subjects did not survive until hospital discharge. Cath lab arrival to intervention time was not different in the two groups (CV (26 [13] minutes; NCV 26 [11] minutes; p=0.94). After adjustment, imaging the CV first had no effect on in-hospital death (p=0.95).
Conclusion:
Imaging the CV first had no effect on time to intervention or mortality. This argues that non-procedural aspects of catheterization (ie prep, drape, access, etc) may be a better target intervention to improve time to PCI. |
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| ISSN: | 1941-7713 1941-7705 |
| DOI: | 10.1161/circoutcomes.8.suppl_2.352 |