open access

Vol 68, No 4 (2010)
Original articles
Published online: 2010-04-23
Submitted: 2012-12-28
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Prediction of long-term outcome after primary percutaneous coronary intervention for acute anterior myocardial infarction

Krystian Wita, Artur Filipecki, Krzysztof Szydło, Maciej Turski, Zbigniew Tabor, Wojciech Wróbel, Marek Elżbieciak, Michał Lelek, Tomasz Bochenek, Maria Trusz-Gluza
Kardiol Pol 2010;68(4):400-407.

open access

Vol 68, No 4 (2010)
Original articles
Published online: 2010-04-23
Submitted: 2012-12-28

Abstract

Background: Despite the widespread use of reperfusion methods, the long-term outcome after primary percutaneous coronary intervention (PCI) is variable, and accurate risk stratification is of clinical importance.
Aim: To assess the predictors of long term outcome after PCI for acute anterior myocardial infarction (AMI).
Methods: One hundred and twenty-seven consecutive patients undergoing PCI within 12 hours from the onset of the first AMI were enrolled. Troponin I, CK-MB, creatinine, NT-proBNP, echocardiographic left ventricular (LV) function, myocardial contrast perfusion, results of coronary angiography, ECG, 24-hour Holter ECG, and T-wave alternans (TWA) were analysed as predictors of major adverse cardiac events (MACE), defined as death, non-fatal reinfarction, sustained ventricular tachycardia, and rehospitalisation for decompensated heart failure. Patients were followed up for two years.
Results: Twenty-seven patients developed MACE. The best predictive model for MACE consisted of impaired perfusion (MCE, myocardial contrast echocardiography), higher CK-MB at 24 hours, discharge NT-proBNP, and non-negative TWA. The combination of elevated creatinine level, decreased LV ejection fraction, and a non-negative TWA proved the best for identification of patients at risk of cardiac death. The best multivariate model for predicting heart failure hospitalisation consisted of higher 24-hour CK-MB, discharge NT-proBNP, impaired perfusion and prolonged duration of ST elevation.
Conclusions: Our study showed that the rate of MACE in patients with anterior ST-segment elevation myocardial infarction undergoing primary PCI at two years follow-up is low. A combined assessment of myocardial contrast perfusion, TWA, CK-MB and discharge NT-proBNP seems to optimally predict patients at risk of MACE.

Abstract

Background: Despite the widespread use of reperfusion methods, the long-term outcome after primary percutaneous coronary intervention (PCI) is variable, and accurate risk stratification is of clinical importance.
Aim: To assess the predictors of long term outcome after PCI for acute anterior myocardial infarction (AMI).
Methods: One hundred and twenty-seven consecutive patients undergoing PCI within 12 hours from the onset of the first AMI were enrolled. Troponin I, CK-MB, creatinine, NT-proBNP, echocardiographic left ventricular (LV) function, myocardial contrast perfusion, results of coronary angiography, ECG, 24-hour Holter ECG, and T-wave alternans (TWA) were analysed as predictors of major adverse cardiac events (MACE), defined as death, non-fatal reinfarction, sustained ventricular tachycardia, and rehospitalisation for decompensated heart failure. Patients were followed up for two years.
Results: Twenty-seven patients developed MACE. The best predictive model for MACE consisted of impaired perfusion (MCE, myocardial contrast echocardiography), higher CK-MB at 24 hours, discharge NT-proBNP, and non-negative TWA. The combination of elevated creatinine level, decreased LV ejection fraction, and a non-negative TWA proved the best for identification of patients at risk of cardiac death. The best multivariate model for predicting heart failure hospitalisation consisted of higher 24-hour CK-MB, discharge NT-proBNP, impaired perfusion and prolonged duration of ST elevation.
Conclusions: Our study showed that the rate of MACE in patients with anterior ST-segment elevation myocardial infarction undergoing primary PCI at two years follow-up is low. A combined assessment of myocardial contrast perfusion, TWA, CK-MB and discharge NT-proBNP seems to optimally predict patients at risk of MACE.
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Keywords

anterior myocardial infarction; contrast echocardiography; NT-proBNP

About this article
Title

Prediction of long-term outcome after primary percutaneous coronary intervention for acute anterior myocardial infarction

Journal

Kardiologia Polska (Polish Heart Journal)

Issue

Vol 68, No 4 (2010)

Pages

400-407

Published online

2010-04-23

Bibliographic record

Kardiol Pol 2010;68(4):400-407.

Keywords

anterior myocardial infarction
contrast echocardiography
NT-proBNP

Authors

Krystian Wita
Artur Filipecki
Krzysztof Szydło
Maciej Turski
Zbigniew Tabor
Wojciech Wróbel
Marek Elżbieciak
Michał Lelek
Tomasz Bochenek
Maria Trusz-Gluza

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