Impaired myocardial perfusion is a major explanation of the poor outcome observed in patients undergoing primary angioplasty for ST-segment-elevation myocardial infarction and signs of heart failure.
BACKGROUND
The aim of the present study was to investigate the prognostic implication of myocardial perfusion in patients with ST-segment-elevation myocardial infarction (STEMI) and signs of heart failure, treated with primary angioplasty.


RESULTS
Our population is represented by 1548 consecutive patients undergoing primary angioplasty for STEMI. Congestive heart failure was defined as Killip class >1 at admission. Killip class was linearly associated with myocardial perfusion, enzymatic infarct size, predischarge ejection fraction, and 1-year mortality rate. Myocardial blush was an independent predictor of 1-year mortality (RR [95% CI]=2.92 [1.37 to 6.23], P=0.005) in patients with advanced Killip class at presentation.


CONCLUSIONS
Our study shows that patients with heart failure complicating STEMI have impaired myocardial perfusion, which accounts for the poor outcome observed in these patients. Further efforts should be aimed at improving myocardial perfusion, beyond epicardial recanalization, to further improve the outcome of these high-risk patients.
Department of Cardiology, ISALA Klinieken, De Weezenlanden Hospital, Zwolle, The Netherlands.
Giuseppe
G
De Luca
Arnoud W J
AW
van 't Hof
Menko-Jan
MJ
de Boer
Jan C A
JC
Hoorntje
A T Marcel
AT
Gosselink
Jan-Henk E
JH
Dambrink
Jan Paul
JP
Ottervanger
Felix
F
Zijlstra
Harry
H
Suryapranata
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D003326:Coronary Circulation; D005260:Female; D006333:Heart Failure / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012720:Severity of Illness Index; D015607:Stents; D016896:Treatment Outcome