Impacto da ruptura da placa aterosclerótica na mortalidade em longo prazo após infarto agudo do miocárdio

Abstract

Background: The presence of atherosclerotic plaque rupture (PR+) is the most frequent substrate of acute coronary syndromes (ACS). In the short-term post-ACS PR+ is associated with a trend toward worse outcomes, including mortality, when compared with ACS without plaque rupture (PR-). However, the influence of PR+ in the long-term outcome after acute myocardial infarction (AMI) is poorly understood. Aims: To test the hypothesis that, in patients with AMI, the presence of PR+ detected at coronary angiography during the index event hospitalization, was correlated with increased all-cause mortality in the long-term follow-up after hospital discharge. Methods: AMI patients (n=500) included prospectively and consecutively in a databank, were followed for up to 17 years (mean 10.3±5.3 years). Angiographic variables were collected at baseline, prior to any coronary intervention, and all coronary angiograms were reviewed by a single experienced intervention cardiologist. The population were divided according their angiographic aspect in PR+ (113, 52%) or PR- (126, 48%). Patients with TIMI flow 0 (n=195) were excluded from the analyses. Kaplan-Meier curves were constructed for each of the groups and compared by the log-rank test. Multivariable Cox proportional hazards model was used in order to adjust for confounders. Results: The mortality rate at 15 years, estimated by Kaplan Meier method, was higher in the PR+ cohort (49.6% vs. 28.0%, respectively; p = 0.0085 by long-rank), as shown in Figure 2 (HR 1.84; 95% CI 1.16-2.93; p = 0.010 by the Cox model). In the multivariate analysis, PR+ correlated independently with a higher risk of long-term mortality (adjusted HR=1.83; 95% CI 1.08 to 3.11; p=0.024). Conclusions: In AMI patients, the presence of angiographic aspect suggestive of PR+ at the culprit coronary artery was independently associated with decreased long-term survival.