Determinants and prognostic implications of persistent ST-segment elevation after primary angioplasty for acute myocardial infarction - Importance of microvascular reperfusion injury on clinical outcome

被引:307
作者
Claeys, MJ
Bosmans, J
Veenstra, L
Jorens, P
De Raedt, H
Vrints, CJ
机构
[1] Univ Antwerp Hosp, Div Cardiol, Dept Cardiol, B-2650 Edegem, Belgium
[2] Univ Antwerp Hosp, Dept Intens Care, Edegem, Belgium
关键词
reperfusion; infarction; angioplasty;
D O I
10.1161/01.CIR.99.15.1972
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background-Despite early recanalization of an occluded infarct artery, reperfusion at the level of the microcirculation may remain impaired owing to a process of microvascular reperfusion injury. Methods and Results-Microvascular reperfusion injury was studied in 91 patients with acute myocardial infarction (AMI) by evaluation of the resolution of ST-segment elevation after successful PTCA. Impaired microvascular reperfusion, defined as the presence of persistent (greater than or equal to 50% of initial value) ST-segment elevation (ST greater than or equal to 50%) at the end of coronary intervention, was observed in 33 patients (36%) and was independently correlated with low systolic pressure on admission and high age. Patients greater than or equal to 55 years of age with systolic pressures less than or equal to 120 mm Hg were at high risk for development of-impaired reperfusion compared with patients not meeting these criteria (72% versus 14%, P<0.001). Impaired microvascular reperfusion was associated with a more extensive infarction and worse clinical outcome at the I-year follow-up: cardiac death rate, 15% versus 2% (ST greater than or equal to 50% versus ST <50%, P=0.01); nonfatal MI rate, 9% versus 2% (P=0.1); and total major adverse cardiac event (MACE) rate, 45% versus 15% (P<0.005). ST greater than or equal to 50% was the most important independent determinant of MACE with an adjusted risk ratio of 3.4. Conclusions-Impaired microvascular reperfusion, as evidenced by ST greater than or equal to 50% after successful recanalization, occurs in more than one third of our AMI patients, especially in older patients with low systolic pressure. Its detrimental implications on clinical outcome reinforce the need to develop adjunctive agents that attenuate the process of reperfusion injury.
引用
收藏
页码:1972 / 1977
页数:6
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共 22 条
  • [11] NO-REFLOW PHENOMENON AFTER TEMPORARY CORONARY-OCCLUSION IN DOG
    KLONER, RA
    GANOTE, CE
    JENNINGS, RB
    [J]. JOURNAL OF CLINICAL INVESTIGATION, 1974, 54 (06) : 1496 - 1508
  • [12] IMPAIRED MYOCARDIAL TISSUE PERFUSION EARLY AFTER SUCCESSFUL THROMBOLYSIS - IMPACT ON MYOCARDIAL FLOW, METABOLISM, AND FUNCTION AT LATE FOLLOW-UP
    MAES, A
    VANDEWERF, F
    NUYTS, J
    BORMANS, G
    DESMET, W
    MORTELMANS, L
    [J]. CIRCULATION, 1995, 92 (08) : 2072 - 2078
  • [13] CARDIAC RELEASE OF CYTOKINES AND INFLAMMATORY RESPONSES IN ACUTE MYOCARDIAL-INFARCTION
    NEUMANN, FJ
    OTT, I
    GAWAZ, M
    RICHARDT, G
    HOLZAPFEL, H
    JOCHUM, M
    SCHOMIG, A
    [J]. CIRCULATION, 1995, 92 (04) : 748 - 755
  • [14] Induction of plasminogen activator inhibitor type 1 and type 1 collagen expression in rat cardiac microvascular endothelial cells by interleukin-1 and its dependence on oxygen-centered free radicals
    Okada, H
    Woodcock-Mitchell, J
    Mitchell, J
    Sakamoto, T
    Marutsuka, K
    Sobel, BE
    Fujii, S
    [J]. CIRCULATION, 1998, 97 (21) : 2175 - 2182
  • [15] THE PATHOGENESIS OF ATHEROSCLEROSIS - A PERSPECTIVE FOR THE 1990S
    ROSS, R
    [J]. NATURE, 1993, 362 (6423) : 801 - 809
  • [16] EXTENT OF EARLY ST SEGMENT ELEVATION RESOLUTION - A STRONG PREDICTOR OF OUTCOME IN PATIENTS WITH ACUTE MYOCARDIAL-INFARCTION AND A SENSITIVE MEASURE TO COMPARE THROMBOLYTIC REGIMENS - A SUBSTUDY OF THE INTERNATIONAL JOINT EFFICACY COMPARISON OF THROMBOLYTICS (INJECT) TRIAL
    SCHRODER, R
    WEGSCHEIDER, K
    SCHRODER, K
    DISSMANN, R
    MEYERSABELLEK, W
    [J]. JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1995, 26 (07) : 1657 - 1664
  • [17] ADJUNCTIVE SELECTIN BLOCKADE SUCCESSFULLY REDUCES INFARCT SIZE BEYOND THROMBOLYSIS IN THE ELECTROLYTIC CANINE CORONARY-ARTERY MODEL
    SILVER, MJ
    SUTTON, JM
    HOOK, S
    LEE, P
    MALYCKY, JL
    PHILLIPS, ML
    ELLIS, SG
    TOPOL, EJ
    NICOLINI, FA
    [J]. CIRCULATION, 1995, 92 (03) : 492 - 499
  • [18] Angiographic assessment of myocardial reperfusion in patients treated with primary angioplasty for acute myocardial infarction - Myocardial blush grade
    van't Hof, AWJ
    Liem, A
    Suryapranata, H
    Hoorntje, JCA
    de Boer, MJ
    Zijlstra, F
    [J]. CIRCULATION, 1998, 97 (23) : 2302 - 2306
  • [19] THROMBOLYSIS FOR ACUTE MYOCARDIAL-INFARCTION - WHY IS THERE NO EXTRA BENEFIT AFTER HOSPITAL DISCHARGE
    VANDEWERF, F
    [J]. CIRCULATION, 1995, 91 (12) : 2862 - 2864
  • [20] Clinical value of 12-lead electrocardiogram after successful reperfusion therapy for acute myocardial infarction
    vantHof, AWJ
    Liem, A
    deBoer, MJ
    Zijlstra, F
    [J]. LANCET, 1997, 350 (9078) : 615 - 619