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Incident myocardial infarction, very late stent thrombosis and their related mortality in stable coronary artery disease outpatients: 5-year follow-up of the CORONOR registry

Session Poster session 1

Speaker Gilles Lemesle

Event : ESC Congress 2017

  • Topic : coronary artery disease, acute coronary syndromes, acute cardiac care
  • Sub-topic : Coronary Artery Disease (Chronic)
  • Session type : Poster Session

Authors : G Lemesle (Lille,FR), O Tricot (Dunkerque,FR), T Meurice (Lille,FR), R Lallemant (Boulogne sur Mer,FR), M Delomez (Lille,FR), O Equine (Bethune,FR), G Schurtz (Lille,FR), N Lamblin (Lille,FR), C Bauters (Lille,FR)

Authors:
G. Lemesle1 , O. Tricot2 , T. Meurice3 , R. Lallemant4 , M. Delomez3 , O. Equine5 , G. Schurtz6 , N. Lamblin6 , C. Bauters6 , 1Centre Hospitalier Régional et Universitaire de Lille, Lille, France; INSERM UMR 1011, Lille, France - Lille - France , 2Centre Hospitalier de Dunkerque - Dunkerque - France , 3Clinique du Bois - Lille - France , 4Centre Hospitalier de Boulogne sur Mer - Boulogne sur Mer - France , 5Centre Hospitalier de Bethune - Bethune - France , 6CHRU Lille - Lille - France ,

On behalf: the CORONOR group

Citation:
European Heart Journal ( 2017 ) 38 ( Supplement ), 186

Rationale: There are limited data on incidence, correlates and prognosis of incident myocardial infarction (MI) in stable coronary artery disease (CAD) outpatients (i.e. at chronological distance of any acute event) in modern practice. Further, the contribution of very late stent thrombosis (VLST) to these events is poorly understood.

Aim and methods: We aimed to analyze the residual risk of MI, factors associated with MI and its related mortality in stable CAD outpatients. The multicenter CORONOR study prospectively enrolled 4184 unselected outpatients with stable CAD defined as previous MI and/or previous coronary revascularization (>1 year ago). Follow-up was obtained at 5 years in 4094 (98%) patients. All events were adjudicated by two investigators with a third opinion in cases of disagreement. Definite VLST was defined according to the definition of the Academic Research Consortium. All MIs were classified as stent thrombosis or as MI not related to a stented site. In 95.5% of the cases, the allocation was angiographically confirmed; in 4.5% of the cases, coronary angiography was not performed but there was no electrocardiographic evidence of acute ischemia in the territory of a previously implanted stent, and these events were categorized as MI not related to a stented site.

Results: Altogether, 170 patients presented 187 incident MIs during follow-up and the risk was linear over-time (0.8% per year). ST-segment elevation MI (STEMI) represented 32% of the cases. LDL-cholesterol, diabetes with HbA1c >7%, current smoking, and multivessel CAD were significantly associated with an increased risk and prior bypass surgery with a decreased risk. When used as a time-dependent variable, incident MI was associated with an increased risk of death (Adjusted HR=2.05 [1.39–3.02], P<0.0001). Among patients with prior stent implantation (n=2883), 121 patients presented 132 incident MIs during follow-up. VLST was the cause of MI in 20% of the cases (n=27, linear risk of 0.15% per year). First-generation drug-eluting stents (DES) were involved in 52% of VLST, second-generation DES in 11%, and bare metal stents in the remainder (37%). In the great majority of the cases (88%), there was no change in antithrombotic treatments within 3 months of VLST. VLST presented more often as STEMI compared to MI at non-stented site (59% vs. 29%, P=0.009). Adjusted mortality was 4-times higher in patients with VLST compared to MI at non-stented site.

Conclusions: MI occurs constantly at an annual rate of 0.8% and is related to VLST in 1/5 of the cases in stable CAD outpatients. Diffuse arthrosclerosis and residual uncontrolled risk factors are strongly associated with MI. Incident MI is associated with an increased risk of mortality especially for VLST.

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