Research Correspondence

DOI: 10.4244/EIJ-D-25-00574

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

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
Volume 22 Number 1
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