Long-term prognostic implications of nonoptimal primary angioplasty for acute myocardial infarction.
OBJECTIVE
To evaluate the long-term outcome of a nonoptimal result of a primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI).


RESULTS
An optimal PCI result was defined as TIMI flow grade 3 and residual stenosis < or = 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, cumulative 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).


CONCLUSIONS
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.
Parodi
Guido
G
Division of Cardiology, Careggi Hospital, Florence, Italy. parodiguido@libero.it
Valenti
Renato
R
Carrabba
Nazario
N
Memisha
Gentian
G
Moschi
Guia
G
Migliorini
Angela
A
Antoniucci
David
D
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy*; D011379:Prognosis; D012107:Research Design; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome