Long-term prognostic implications of nonoptimal primary angioplasty for acute myocardial infarction.

@article{citeulike:688912, abstract = {Aim: To evaluate the long-term outcome of a nonoptimal result of a primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI). Methods and Results: An optimal PCI result was defined as TIMI flow grade 3 and residual stenosis </=</=</=</=20\%. Long-term clinical follow-up (51 +/-+/- 21 months) data were collected from 1,009 consecutive patients with ST-elevation AMI who underwent primary PCI. Overall, an optimal primary PCI result was achieved in 958 patients (95\%). At 5-year follow-up, patients with nonoptimal PCI had a higher rate of all-cause mortality (47\% vs 19\%; P < 0.00001 by log-rank test) than those with an optimal mechanical reperfusion. Fifty-two percent of the deaths in the nonoptimal PCI group occurred within the first month. Interestingly, after this period, estimated survival of 30-day alive patients was not significantly different to that of patients with an optimal PCI (P = 0.06 by log-rank test). Nonoptimal PCI result emerged as an independent predictor of 1-month mortality (OR = 3.030, 95\% CI = 1.265-7.254; P = 0.013), but not of 5-year mortality. At long-term follow-up, comulative rates of nonfatal reinfarction, hospitalization for heart failure, and additional revascularization procedures were similar between patients with nonoptimal and optimal primary PCI (4\% vs 5\%, P = 0.695; 4\% vs 5\%, P = 921; and 22\% vs 20\%, P = 0.816, respectively). Conclusion: A nonoptimal primary PCI result represents a strong predictor of early mortality. However, in patients surviving the early phase, the incidence of clinical events at long-term follow-up seems to be similar to successfully reperfused AMI patients. (c) 2006 Wiley-Liss., Inc.}, address = {Division of Cardiology, Careggi Hospital, Florence, Italy.}, author = {Parodi, Guido and Valenti, Renato and Carrabba, Nazario and Memisha, Gentian and Moschi, Guia and Migliorini, Angela and Antoniucci, David }, citeulike-article-id = {688912}, doi = {http://dx.doi.org/10.1002/ccd.20729}, issn = {1522-1946}, journal = {Catheter Cardiovasc Interv}, keywords = {cardiac}, month = {June}, posted-at = {2006-06-07 20:36:34}, priority = {2}, title = {Long-term prognostic implications of nonoptimal primary angioplasty for acute myocardial infarction.}, url = {http://dx.doi.org/10.1002/ccd.20729}, year = {2006} }

TY - JOUR ID - citeulike:688912 L3 - citeulike-article-id:688912 TI - Long-term prognostic implications of nonoptimal primary angioplasty for acute myocardial infarction. JF - Catheter Cardiovasc Interv AD - Division of Cardiology, Careggi Hospital, Florence, Italy. SN - 1522-1946 N2 - Aim: To evaluate the long-term outcome of a nonoptimal result of a primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI). Methods and Results: An optimal PCI result was defined as TIMI flow grade 3 and residual stenosis </=</=</=</=20%. Long-term clinical follow-up (51 +/-+/- 21 months) data were collected from 1,009 consecutive patients with ST-elevation AMI who underwent primary PCI. Overall, an optimal primary PCI result was achieved in 958 patients (95%). At 5-year follow-up, patients with nonoptimal PCI had a higher rate of all-cause mortality (47% vs 19%; P < 0.00001 by log-rank test) than those with an optimal mechanical reperfusion. Fifty-two percent of the deaths in the nonoptimal PCI group occurred within the first month. Interestingly, after this period, estimated survival of 30-day alive patients was not significantly different to that of patients with an optimal PCI (P = 0.06 by log-rank test). Nonoptimal PCI result emerged as an independent predictor of 1-month mortality (OR = 3.030, 95% CI = 1.265-7.254; P = 0.013), but not of 5-year mortality. At long-term follow-up, comulative rates of nonfatal reinfarction, hospitalization for heart failure, and additional revascularization procedures were similar between patients with nonoptimal and optimal primary PCI (4% vs 5%, P = 0.695; 4% vs 5%, P = 921; and 22% vs 20%, P = 0.816, respectively). Conclusion: A nonoptimal primary PCI result represents a strong predictor of early mortality. However, in patients surviving the early phase, the incidence of clinical events at long-term follow-up seems to be similar to successfully reperfused AMI patients. (c) 2006 Wiley-Liss., Inc. KW - cardiac AU - Parodi, Guido AU - Valenti, Renato AU - Carrabba, Nazario AU - Memisha, Gentian AU - Moschi, Guia AU - Migliorini, Angela AU - Antoniucci, David PY - 2006/06/05/ UR - http://dx.doi.org/10.1002/ccd.20729 ER -