Predictors and long-term prognosis of left ventricular aneurysm in patients with acute anterior myocardial infarction treated with primary percutaneous coronary intervention in the contemporary era

Abstract

Background: Primary percutaneous coronary intervention (PCI) has been the standard reperfusion strategy for patients with acute myocardial infarction (AMI) in the contemporary era. Meanwhile, the incidence and prognosis of left ventricular aneurysm (LVA) in AMI patients remain ambiguous. The aim of the current study is to identify the predictor and long-term prognosis of LVA in patients with acute anterior myocardial infarction.

Methods: We prospectively enrolled 942 consecutive patients with acute anterior myocardial infarction who were treated by primary PCI. The baseline characteristics, procedural features, and one-year clinical outcomes were compared between the patients with and without LVA. The primary endpoint of major adverse cardiovascular and cerebrovascular events (MACCEs) was defined as a composite of cardiac death, target vessel revascularization, and ischemic stroke. Multiple logistic regression was applied to predict LVA formation and the receiver operating characteristic (ROC) curves were plotted to evaluate the accuracy of the multivariate analysis model.

Results: The general incidence of LVA was 15.92%. At one-year clinical follow-up, patients in the LVA group had significantly higher incidence of MACCEs (15.33% vs. 6.44%, P<0.01), mainly driven by an increased incidence of cardiac death (8.00% vs. 2.78%, P<0.01), target vessel revascularization (5.33% vs. 2.27%, P=0.03), and ischemic stroke (4.00% vs. 1.39%, P=0.03). Multivariate analysis found that longer symptom-to-balloon time (S2B) [odds ratio (OR): 1.16, 95% confidence interval (CI): 1.11-1.21, P<0.01], higher initial and residual SYNTAX score (iSS, OR: 1.19, 95% CI: 1.14-1.24, P<0.01; rSS, OR: 1.33, 95% CI: 1.22-1.45, P<0.01), lower left ventricular ejection fraction (LVEF) (OR: 1.15, 95% CI: 1.11-1.18, P<0.01), and persistent ST segment elevation (OR: 1.89, 95% CI: 1.06-3.38, P=0.03) were independent predictors of LVA formation.

Conclusions: LVA is still common in patients with acute anterior myocardial infarction in the contemporary PCI era, and the prognosis of these patients was significantly worse during the one-year clinical follow-up. Strategies of prompt reperfusion and complete revascularization may be helpful in preventing LVA formation and improving clinical outcomes.

Keywords: Left ventricular aneurysm (LVA); acute anterior myocardial infarction; percutaneous coronary intervention (PCI); prognosis.

Figure 1

Study flowchart. PCI, percutaneous coronary intervention; non-LVA, patients without left ventricular aneurysm; LVA, patients with left ventricular aneurysm.

Figure 2

Adverse events of MACCEs. MACCEs, major adverse cardio-cerebral events; TVR, target vessel revascularization; LVA, left ventricular aneurysm.

Figure 3

Forest plot for the multivariate logistical regression analysis. S2B, symptom-to-balloon time; LVEF, left ventricular ejection fraction; iSS, initial SYNTAX score; rSS, residual SYNTAX score.

Figure 4

Receiver operating characteristic (ROC) curves. S2B, symptom-to-balloon time; iSS, initial SYNTAX score; rSS, residual SYNTAX score; LVEF, left ventricular ejection function.