Reperfusion after primary angioplasty for ST-elevation myocardial infarction: predictors of success and relationship to clinical outcomes in the APEX-AMI Angiographic Study

被引:53
作者
Brener, Sorin J. [2 ]
Moliterno, David J. [3 ]
Aylward, Philip E. [4 ]
van't Hof, Arnoud W. J. [5 ]
Ruzyllo, Witold [6 ]
O'Neill, William W. [7 ]
Hamm, Christian W. [8 ]
Westerhout, Cynthia M. [1 ]
Granger, Christopher B. [9 ]
Armstrong, Paul W. [1 ]
机构
[1] Univ Alberta, Edmonton, AB, Canada
[2] Cleveland Clin Fdn, Cleveland, OH 44195 USA
[3] Univ Kentucky, Div Cardiovasc Med, Lexington, KY USA
[4] Flinders Med Ctr, Bedford Pk, SA, Australia
[5] Isala Klin, De Weezenlanden, Zwolle, Netherlands
[6] Natl Inst Cardiol, Warsaw, Poland
[7] Univ Miami, Miami, FL 33152 USA
[8] Kerckhoff Heart Ctr, Bad Nauheim, Germany
[9] Duke Univ, Med Ctr, Durham, NC USA
关键词
reperfusion; primary PCI; outcomes;
D O I
10.1093/eurheartj/ehn125
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Aims We studied the clinical, demographic, and angiographic factors associated with successful reperfusion and the relationship between angiographic indices and clinical outcomes in a subset of the APEX-AMI trial, which tested the efficacy of pexelizumab in ST-elevation myocardial infarction patients undergoing primary percutaneous coronary intervention (PCI). Methods and results Among 5745 patients enrolled in the trial, 1018 underwent independent quantitative angiographic evaluation by a core laboratory. Successful epicardial reperfusion was defined as TIMI (thrombolysis in myocardial infarction) flow grade 3 or corrected TIMI frame count (cTFC) < 28 frames, and successful myocardial reperfusion as TIMI myocardial perfusion grade (TMPG) 2 or 3. TIMI 3 flow after PCI occurred in 85%, cTFC < 28 in 58% (mean cTFC was 27 +/- 20), and TMPG 2 or 3 in 91%. Overall 90 day clinical outcomes were 2.7% for mortality and 8.2% for the composite of death, congestive heart failure (CHF), or shock. After adjustment for baseline characteristics, TMPG 2/3 after PCI was associated with younger age [odds ratio (OR) for 10 year increase 0.75, 95% confidence interval (CI) 0.59-0.96, P = 0.023], pre-PCI TIMI flow 2/3 (OR 3.5, 95% CI 1.7-7.1, P = 0.001), and ischaemic time [for every hour, OR 0.81 (0.69-0.96), P = 0.015]. TMPG 2/3 after PCI was significantly associated with 90 day mortality (adjusted hazard ratio 0.26, 95% CI 0.09-0.78, P = 0.013). Neither post-PCI TMPG nor TIMI flow grade was significantly associated with 90 day death/CHF/shock. Conclusion Younger age, patent infarct-related artery at presentation, and ischaemic time predicted higher likelihood of successful myocardial perfusion, which was associated with improved survival.
引用
收藏
页码:1127 / 1135
页数:9
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