A new study published in the Journal of the American Heart Association shows that AMIs following a percutaneous coronary intervention (PCI) is twice as likely to originate from untreated lesions versus previous stented lesions. Interesting since this information seems to differ from previous studies such as PROSPECT which show a near equal risk between culprit and non-culprit lesions.
This large retrospective study looks at 108,615 patients suffering an initial heart attack between 2006 and 2014. In over 10 percent of those patients, a second heart attack occurred within 4 years. In a majority of patients, the second AMI was found to be attributable to a lesion previously identified as non-culprit.
Previous studies like PROSPECT included a composite of symptoms including death from cardiac causes, cardiac arrest, MI, rehospitalization for unstable or progressive angina, revascularization and stent thrombosis while this study focused specifically on MI.
The Key Takeaways and Questions
We need a better understanding of how long‐term disease progression affects future MIs and whether reinfarction occurs in previously stented lesions or in new or progressive lesions as a result of decisions about medical treatment after the first myocardial infarction. Should patients with multivessel disease have a different follow-up than those with single vessel disease?
It seems that improved stenting techniques, better stents, and improved antithrombotic treatment for intermediate phase do have an impact on adverse outcomes. Is it possible that the impact is less when considering overall disease progress than focusing on the risk of non-culprit lesions related to future adverse outcomes?
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