Patency of infarct related artery after pharmacological reperfusion during transfer to primary percutaneous coronary intervention influences left ventricular function and one-year clinical outcome.
BACKGROUND
Time-to-treatment is an important determinant of mortality in primary angioplasty for ST-segment elevation myocardial infarction (STEMI). Thus, the benefits in outcome observed with transferring for primary angioplasty in comparison with on-site thrombolysis may be reduced or even lost when long-distance transportation is required. Even though pharmacological reperfusion might overcome this limitation, no data have been reported so far on the prognostic role of early pharmacological recanalization in STEMI patients undergoing long-distance transportation for primary angioplasty.


METHODS
We enrolled 225 consecutive STEMI patients without shock, eligible for thrombolysis, with at least 90-minute transport time to our primary PCI center. During transport, patients received i.v. heparin 40 U/kg, alteplase 15 mg+35 mg infusion and abciximab 0.25 mg/kg+0.125 microg/kg/min infusion for 12 h.


RESULTS
Patients were divided into two groups according baseline angiography, which showed early pharmacological reperfusion (preprocedural TIMI flow 2+3) in 193 patients (85.8%) and no reperfusion (preprocedural TIMI flow 0+1) in 32 patients (14.2%). Despite no difference in postprocedural TIMI flow, early reperfusion was associated with better postprocedural myocardial perfusion (TMPG 3: 54.9% vs. 18.7%, p<0.0001), better improvement in left ventricular ejection fraction (LVEF) (from 55.6+/-8.6% to 58.8+/-10.4% p<0.001 with early reperfusion vs. 52.9+/-13.4% to 50.4+/-15.8% with no early reperfusion, p=NS) and 1-year outcome (p=0.002 log rank). In multivariate analysis, preprocedural TIMI flow 0+1 independently predicted death and reinfarction at 1 year, and lack of LVEF improvement at 6 months.


CONCLUSIONS
Early pharmacological reperfusion in STEMI patients undergoing long-distance transportation for primary angioplasty is associated with better postprocedural myocardial perfusion, better LVEF recovery at 6 months and improved 1-year clinical outcome.
Dudek
Dariusz
D
2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland. mcdudek@cyf-kr.edu.pl
Rakowski
Tomasz
T
El Massri
Nader
N
Sorysz
Danuta
D
Zalewski
Jaroslaw
J
Legutko
Jacek
J
Dziewierz
Artur
A
Rzeszutko
Lukasz
L
Zmudka
Krzysztof
K
Piwowarska
Wieslawa
W
De Luca
Giuseppe
G
Kaluza
Grzegorz L
GL
Janion
Marianna
M
Dubiel
Jacek S
JS
D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D017023:Coronary Angiography; D003325:Coronary Care Units; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000628:therapy; D015425:Myocardial Reperfusion / Q000379:methods*; D010360:Patient Transfer / Q000379:methods*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency / Q000502:physiology*; D016277:Ventricular Function, Left / Q000502:physiology*
D005343:Fibrinolytic Agents