European Heart Journal Advance Access originally published online on March 27, 2008
European Heart Journal 2008 29(9):1127-1135; doi:10.1093/eurheartj/ehn125
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Reperfusion after primary angioplasty for ST-elevation myocardial infarction: predictors of success and relationship to clinical outcomes in the APEX-AMI Angiographic Study
yllo5
1 Cleveland Clinic Foundation, Cleveland, OH, USA
2 Division of Cardiovascular Medicine, University of Kentucky, Lexington, KY, USA
3 Flinders Medical Centre, Bedford Park, Australia
4 Isala Klinieken, De Weezenlanden, Zwolle, The Netherlands
5 National Institute of Cardiology, Warsaw, Poland
6 University of Miami, Miami, FL, USA
7 Kerckhoff Heart Centre, Bad Nauheim, Germany
8 University of Alberta, Edmonton, Alberta, Canada
9 Duke University Medical Centre, Durham, NC, USA
Received 1 October 2007; revised 15 February 2008; accepted 29 February 2008; online publish-ahead-of-print 27 March 2008.
* Corresponding author. Tel: +1 780 492 0591, Fax: +1 780 492 9486, Email: paul.armstrong{at}ualberta.ca
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.
Key Words: Reperfusion • Primary PCI • Outcomes
This paper was guest edited by Professor Christiaan J.M. Vrints, Department of Cardiology, University Hospital Antwerp, University of Antwerp, Edegem, Belgium.