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

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 long-term outcomes. Prognosis was mainly driven by myocardial function and systemic clinical factors.