The Association between the Infarct-Related Artery and in-Hospital and Long-Term Mortality and Major Adverse Cardiovascular Events in Patients with ST-Segment Elevation Myocardial Infarction

Abstract

Introduction: Despite advances in percutaneous coronary intervention (PCI), ST-segment elevation myocardial infarction (STEMI) remains associated with substantial morbidity and mortality, and the prognostic relevance of the infarct-related artery (IRA) remains controversial. Aim: This study evaluated the association between IRA location and in-hospital and long-term mortality and major adverse cardiovascular events (MACE) in STEMI patients undergoing primary PCI. Material and methods: This retrospective study included 693 consecutive STEMI patients treated with primary PCI between January 2015 and January 2016, with a mean follow-up of 103 months. Patients were classified according to IRA location as left anterior descending artery (LAD), left circumflex artery (LCx), or right coronary artery (RCA). In-hospital and long-term mortality and MACE were assessed. Results: Baseline characteristics were similar among groups. Left ventricular ejection fraction (LVEF) was significantly lower in the LAD group (p < 0.001). Cardiac arrest on admission was more frequent in LAD-related STEMI, while atrioventricular block was more common with RCA involvement. In multivariable analysis, reduced LVEF and lower serum albumin independently predicted in-hospital mortality, whereas RCA involvement was associated with higher in-hospital mortality compared with LAD. For long-term outcomes, LVEF remained the strongest independent predictor of all-cause mortality, while multivessel disease showed a borderline association. Long-term MACE was independently associated with male sex, ventricular function, renal function, and hemoglobin levels. Kaplan-Meier analyses demonstrated similar long-term survival and MACE rates across IRA groups. Conclusions: In STEMI patients undergoing primary PCI, IRA location was not an independent determinant of short-or longterm outcomes. Prognosis was mainly driven by myocardial function and systemic clinical factors.