title: [Effect of successful late reperfusion by primary coronary angioplasty on mechanical complications of acute myocardial infarction].
abstract: It has been suggested that early treatment decreases, but late treatment increases, the risk of mechanical complications for a thrombolytic strategy. However, few studies have evaluated whether late reperfusion by primary coronary angioplasty decreases the risk of mechanical complications. A total of 2,209 patients with acute myocardial infarction treated with primary coronary angioplasty within 24 hr after the onset of symptoms were divided into three groups: early reperfusion (ER; <- 12 hr, n = 1,647), late reperfusion (LR; > 12 hr, n = 219), and failed reperfusion (RF; n = 343). We evaluated the incidence, risk ratio, and predictors of mechanical complication. The overall incidence of mechanical complications was 2.0%. The incidence of mechanical complications was highest in the FR group (ER 1.4%, LR 1.8%, FR 5.0%, p <0.01). After adjusting for clinical variables, the risk ratio for mechanical complications increased in the FR group compared with LR group [risk ratio 7.34, 95% confidence interval (CI) 1.02 - 52.80, p = 0.04]. Predictors of an increased risk of mechanical complications by multivariate analysis were age >- 70 years (odds ratio 3.68, 95% CI 1.56-8.64, p < 0.01), Killip class >- II (odds ratio 3.73, 95% CI 1.52-9.12, p >- 0.01), absence of collateral vessels (odds ratio 4.09, 95% CI 1.17-14.26, p = 0.03), and FR (odds ratio 2.68, 95% CI 1.01-6.61, p = 0.03). In conclusion, successful late reperfusion by primary coronary angioplasty is associated with the reduced risk of mechanical complications in patients with acute myocardial infarction.
authors.forename: Daisaku
authors.initials: D
authors.lastname: Nakatani
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Sato
authors.forename: Kunihiro
authors.initials: K
authors.lastname: Kinjo
authors.forename: Hiroya
authors.initials: H
authors.lastname: Mizuno
authors.forename: Eiji
authors.initials: E
authors.lastname: Hishida
authors.forename: Atsushi
authors.initials: A
authors.lastname: Hirayama
authors.forename: Masayoshi
authors.initials: M
authors.lastname: Mishima
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ito
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Matsumura
authors.forename: Masatsugu
authors.initials: M
authors.lastname: Hori
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects*; D006801:Humans; D008944:Mitral Valve Insufficiency / Q000209:etiology; D009203:Myocardial Infarction / Q000628:therapy*; D015425:Myocardial Reperfusion / Q000379:methods*; D012306:Risk; D013997:Time Factors; D018658:Ventricular Septal Rupture / Q000209:etiology