Management and outcomes of patients with ST-segment elevation myocardial infarction and large infarct-related arteries

Marc Bonnet¹, MD; Loïc Belle¹, MD; Hugo Pilichowski¹, MD; Emmanuel Cassar¹, MD; Stéphane Rias², MD; Jean-François Morelle³, MD; Géraldine Gibault Genty⁴, MD; Vincent Roule⁵, MD; Hugo Verheyde⁶, MD; Christophe Pouillot⁷, MD; Sylvain Chanseaume⁸, MD; Sébastien Hess⁹, MD; Julien Jeanneteau¹⁰, MD; Nicolas Durel¹¹, MD; Philippe Riccini¹², MD; Vincent Tixier¹³, MD; Tahar Lazizi¹⁴, MD; Antoine Gommeaux¹⁵, MD; François Tarragano¹⁶, MD, PhD; Thomas Cuisset¹⁷, MD, PhD; Gilles Barone Rochette¹⁸, MD, PhD; Stephan Chassaing¹⁹, MD; Guillaume Cayla²⁰, MD, PhD; Philippe Commeau²¹, MD; Hakim Benamer²², MD; René Koning²³, MD; Eric Van Belle²⁴, MD, PhD; Michel Zeitouni²⁵, MD, PhD; Etienne Puymirat²⁶, MD, PhD; Lionel Mangin¹, MD; Pascal Motreff²⁷, MD, PhD; Grégoire Rangé²⁸, MD

1. Cardiology Department, Hospital Annecy-Genevois, Metz-Tessy, France; 2. Cardiology Department, Centre Hospitalier Métropole Savoie, Chambéry, France; 3. Cardiology Department, Hôpital privé Saint-Martin Caen, Caen, France; 4. Cardiology Department, Centre Hospitalier de Versailles, Le Chesnay-Rocquencourt, France; 5. Cardiology Department, Centre Hospitalier Public du Cotentin, Cherbourg-en-Cotentin, France; 6. Cardiology Department, Centre Hospitalier de Lens, Lens, France; 7. Cardiology Department, Clinique Sainte-Clotilde, Saint-Denis, La Réunion, France; 8. Cardiology Department, Centre Hospitalier Montluçon, Montluçon, France; 9. Cardiology Department, Clinique Rhéna Strasbourg, Strasbourg, France; 10. Cardiology Department, Clinique Saint Joseph, Trélazé, France; 11. Cardiology Department, Pôle Santé République, Clermont-Ferrand, France; 12. Cardiology Department, Centre Hospitalier de Bastia, Bastia, Corse, France; 13. Cardiology Department, Centre Hospitalier de Vichy, Vichy, France; 14. Cardiology Department, Centre Hospitalier de Laval, Laval, France; 15. Cardiology Department, Hôpital privé de Bois-Bernard, Bois-Bernard, France; 16. Cardiology Department, Hôpital Américain de Paris, Neuilly-sur-Seine, France; 17. Cardiology Department, Hôpitaux Universitaires de Marseille, Marseille, France; 18. Cardiology Department, CHU Grenoble Alpes, Échirolles, France; 19. Cardiology Department, Nouvelle Clinique Tourangelle, Saint-Cyr-sur-Loire, France; 20. Cardiology Department, Nimes University Hospital, Montpellier University, Nimes, France; 21. Cardiology Department, Polyclinique Les Fleurs, Groupe ELSAN, Ollioules, France; 22. Cardiology Department, ICVGVM La Roseraie, Aubervilliers, France; 23. Cardiology Department, Clinique Saint-Hilaire, Rouen, France; 24. Cardiology Department, Institut Coeur-Poumon-CHU Lille and INSERM U1011, Lille, France; 25. Cardiology Department, AP-HP Hôpital Universitaire Pitié Salpêtrière, Paris, France; 26. Cardiology Department, Hôpital Européen Georges-Pompidou, Paris, France; 27. Cardiology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France; 28. Cardiology Department, Les Hôpitaux de Chartres, Chartres, France

Optimal medical and interventional approaches in patients with ST-segment elevation myocardial infarction (STEMI) and large (L-) infarct-related arteries (IRAs) remain unclear. This study investigated the management and outcomes of patients with STEMI according to IRA diameter.

The design of this prospective cohort study (France PCI registry; ClinicalTrials.gov: NCT02778724), conducted in 45 French centres, has been described1. Consecutive patients who underwent primary percutaneous coronary intervention for STEMI from 2014-2022 with available data for IRA diameter were included. Left main or coronary artery bypass grafting IRAs were excluded. STEMI was defined according to the Fourth Universal Definition of MI (4UDMI). The French Persons Protection Committee (IRB00003888) and Data Protection Commission (no. 2014-073) approved the study.

IRA size was defined angiographically at the end of the index procedure. A segment ≥5 mm at the culprit lesion’s site or proximal/distal to it was classified as an L-IRA. Initial reperfusion without stenting, reassessed at 1 month, was defined as minimalist immediate mechanical intervention (MIMI). Follow-up data were collected prospectively by individuals blinded to IRA size.

To capture both ischaemic and bleeding events related to an increased atheromatous...

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Volume 22 Number 1

Jan 5, 2026