title: [Prediction of adverse cardiac events in patients with acute anterior wall myocardial infarction treated with PCI].
abstract: Despite common use of reperfusion therapy, particularly primary PCI during acute myocardial infarction, steadily increasing number of patients with low left ventricular ejection fraction, with heart failure (HF), requiring frequent rehospitalisation justifies the study establishing the best indices of prediction of major adverse cardiac events (MACE) occurrence. The aim of the study was to define the frequency of MACE (death, re MI, sVT, rehospitalisation for HF) in patients with acute anterior wall myocardial infarction in 6 month follow up and the factors determinatig its occurence. The 115 consecutive patients (86 males of age 57.7 +/- 11 yrs) with first anterior MI were studied. After successful PCI (TIMI 3) the angiographic assessment was performed (MBG 0-1 - no perfusion, MBG 2-3 - perfusion preserved). During first 48 hours 12-lead ECG was monitored in order to analyse the time to reduction of ST elevation in the lead with the highest elevation (deltatST 50%). On 2nd day LV function (LVEF and WMSI) and dyssfunctional segment perfusion (RPSI) were assessed. On 5th day Holter monitoring with arrhythmia and time domain parameters (SDNN, rMSSD) of heart rate variability were performed, on 30 day TWA test was done.
  
  
  RESULTS
  During 180 follow-up 18 MACE occurred (3 death, 2 MI, 11 rehospitalisations for HF). In univariate analysis cigarette smoking, higher maximum troponin I value, LVEDV, LVESV, ST elevation sum, longer time to reduction of ST elevation, lower LVEF and RPSI, lack of microvessel integrity and positive TWA test had significant relationship with occurrence of MACE. The multivariate analysis of Cox proportional risk regression demonstrated that only lower value of RPSI and LVEF, longer time of ST elevation reduction in the lead with the highest ST elevation and positive TWA test were independent indices of MACE prediction.
  
  
  CONCLUSIONS
  Cumulative evaluation of LVEF, indices of preserved perfusion and results of TWA test turned out to be the best predictors of MACE occurrence in 6 month follow up in patients after anterior MI treated with PCI.
authors.affiliation: Klinika Kardiologii, Slaska Akademia Medyczna. welwetek@poczat.onet.pl
authors.forename: Krystian
authors.initials: K
authors.lastname: Wita
authors.forename: Artur
authors.initials: A
authors.lastname: Filipecki
authors.forename: Jan
authors.initials: J
authors.lastname: Szczogiel
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Drzewiecka-Gerber
authors.forename: Anna
authors.initials: A
authors.lastname: Rybicka
authors.forename: Jolanta
authors.initials: J
authors.lastname: Krauze
authors.forename: Wojciech
authors.initials: W
authors.lastname: Wróbel
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Szydło
authors.forename: Dagmara
authors.initials: D
authors.lastname: Urbańczyk
authors.forename: Maciej
authors.initials: M
authors.lastname: Turski
authors.forename: Zbigniew
authors.initials: Z
authors.lastname: Tabor
authors.forename: Wojciech
authors.initials: W
authors.lastname: Kwaśniewski
authors.forename: Ilona
authors.initials: I
authors.lastname: Mróz
authors.forename: Maria
authors.initials: M
authors.lastname: Trusz-Gluza
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D017023:Coronary Angiography; D018572:Disease-Free Survival; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy*; D015425:Myocardial Reperfusion; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012720:Severity of Illness Index; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis* / Q000503:physiopathology