Markers of Reperfusion and Long-Term (8-Year) Prognosis after Primary Percutaneous Coronary Intervention
Ndrepepa G, Byrne RA, Cassese S, Fusaro M, Colleran R, Hieber J, Laugwitz KL, Schunkert H, Kastrati A (2018)
Publication Type: Journal article
Publication year: 2018
Journal
Book Volume: 122
Pages Range: 39-46
Journal Issue: 1
DOI: 10.1016/j.amjcard.2018.03.353
Abstract
Thrombolysis in Myocardial Infarction (TIMI) flow, myocardial perfusion grade (MPG), and infarct size are established markers of reperfusion in patients with ST-segment elevation myocardial infarction. Whether these markers provide long-term prognostic information remains unknown. This study included 1,406 patients with ST-segment elevation myocardial infarction who underwent primary percutaneous coronary intervention. Postreperfusion TIMI flow, MPG, and infarct size (evaluated by scintigraphy at 7 to 14 days) were measured. The primary outcome was 8-year mortality. Overall there were 190 deaths. The Kaplan-Meier estimates of mortality were 22.6% (37 deaths) and 16.8% (153 deaths) according to TIMI flow ≤2 and TIMI flow 3 (adjusted hazard ratio [HR] 0.82, 95% confidence interval [CI] 0.66 to 1.00, p = 0.058 for 1 grade increment), 21.6% (106 deaths) and 14.5% (84 deaths) according to MPG ≤2 and MPG 3 (adjusted HR 0.87 [0.77 to 0.98], p = 0.020 for 1 grade increment) and 21.7% (115 deaths) and 13.7% (75 deaths) according to infarct size >10% (median value) and infarct size ≤10% of the left ventricle (adjusted HR 1.08 [1.03 to 1.13], p = 0.001, for 5% of left ventricle increment in infarct size). The C statistic of the model for all-cause mortality was 0.810 (0.781 to 0.839) with baseline variables, 0.812 (0.783 to 0.841) after incorporation of TIMI flow (P for significance compared to the model with baseline variables = 0.140), 0.813 (0.784 to 0.841) after incorporation of MPG (p = 0.345) and 0.815 (0.786 to 0.842) after incorporation of infarct size (p = 0.08). In conclusion, markers of reperfusion independently predict long-term mortality after primary percutaneous coronary intervention but offer limited incremental prognostic value to that provided by evaluation of baseline cardiovascular risk factors and clinical data.
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Germany (DE)How to cite
APA:
Ndrepepa, G., Byrne, R.A., Cassese, S., Fusaro, M., Colleran, R., Hieber, J.,... Kastrati, A. (2018). Markers of Reperfusion and Long-Term (8-Year) Prognosis after Primary Percutaneous Coronary Intervention. American Journal of Cardiology, 122(1), 39-46. https://doi.org/10.1016/j.amjcard.2018.03.353
MLA:
Ndrepepa, Gjin, et al. "Markers of Reperfusion and Long-Term (8-Year) Prognosis after Primary Percutaneous Coronary Intervention." American Journal of Cardiology 122.1 (2018): 39-46.
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