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

• Published in: Catheterization and cardiovascular interventions Vol. 68; no. 1; pp. 50 - 55
• Main Authors: Parodi, Guido, Valenti, Renato, Carrabba, Nazario, Memisha, Gentian, Moschi, Guia, Migliorini, Angela, Antoniucci, David
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc., A Wiley Company 01.07.2006
• Subjects: Aged; angioplasty; Angioplasty, Balloon, Coronary - mortality; Female; Follow-Up Studies; Humans; Male; Middle Aged; myocardial infarction; Myocardial Infarction - mortality; Myocardial Infarction - therapy; Prognosis; Research Design; survival; Survival Analysis; Time Factors; Treatment Outcome
• ISSN: 1522-1946; 1522-726X
• DOI: 10.1002/ccd.20729

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. © 2006 Wiley‐Liss., Inc.