Determinants and Prognostic Implications of Reperfusion Injury During Primary Percutaneous Coronary Intervention in Chinese Patients with Acute Myocardial Infarction

Background: The poor clinical outcome in acute myocardial infarction (AMI) patients undergoing primary percutaneous coronary intervention (PCI) has been attributed to myocardial ischemia-reperfusion injury (MIRI). Objective: This study aimed to identify the predictive factors of MIRI during PCI in Chinese AMI patients with or without ST-segment elevation. Methods: Clinical and angiographic data Of 228 patients in whom the infarct-retated artery (IRA) was successfully recanalized by primary PCI were retrospectively analyzed. Multiple logistic regressions were used. Results: Compared with non-MIRI group (n = 109), patients with MIRI (n = 119) were characterized by more inferior infarct location, shorter ischemic duration, more frequently right coronary artery as IRA, more lesion vessels, more often thrombolysis in myocardial infarction (TIMI) o flow in IRA prior to PCI, less preinfarction angina, and more renal insufficiency. Ischemic time <= 6 hours (p = 0.014), inferior infarct location (p = 0.006), and initial antegrade flow in IRA <= TIMI grade 1 (p = 0.028) were independent risk factors for MIRI. Other risk factors included multivessel lesions (p = 0.063) and renal insufficiency (p = 0.067). Only preinfarction angina was a protective factor (p = 0.005). Conclusions: The factors promoting MIRI during primary PCI includes short ischemic time from AMI onset to IRA recanalization, inferior infarct location, low IRA antegrade flow prior to PCI, multivessel lesions, and renal insufficiency, whereas preinfarction angina is a protective factor attenuating MIRI.