title: The effects of facilitated primary PCI by guide wire on procedural and clinical outcomes in acute ST-segment elevation myocardial infarction.
abstract: BACKGROUND
  Reperfusion of the infarct related artery (IRA) prior to PCI is prognostically important in patients with acute ST segment elevation myocardial infarction (STEMI). Reperfusion is either achieved spontaneously, facilitated by GP IIb/ IIIa inhibitors, or mechanically by crossing the guide wire beyond the lesion. In order to test the hypothesis that a visible coronary anatomy is independently associated with procedural and clinical outcomes, we evaluated the frequency and prognostic impact of guide wire facilitated reperfusion of the IRA before primary PCI.
  
  
  RESULTS
  We enrolled 311 consecutive patients with successful primary PCI for STEMI (TIMI grade > or =2 flow) within 12 h after onset of symptoms. Among these, 90 patients (28.9%) had a spontaneously reperfused IRA on initial angiogram, 56 patients (18.0%) achieved reperfusion after crossing of the guide wire, and 165 patients (53.1%) successful reperfusion only after PCI. Variables associated with successful guide wire facilitated reperfusion were younger age, no history of arterial hypertension, active smoking status, negative cardiac troponin T on admission, and an infarct in the territory of the right coronary artery. Patients with spontaneous reperfusion or reperfusion after crossing of the guide wire required less fluoroscopic time and less contrast material during angiography and had higher procedural success rates (TIMI grade 3 flow 91.1 vs 79.4%, p=0.048) than patients without initial reperfusion. In addition, patients with reperfusion after crossing the lesion with the guide wire had lower mortality rates at 30 days (3.6 vs 9.1%) and after a median of 16 months (3.6 vs 13.9%, p=0.03) than those with reperfusion after PCI.
  
  
  CONCLUSIONS
  Reperfusion of an occluded IRA by crossing the guide wire is associated with higher procedural success rates and better outcomes. Better roadmapping and device selection represent potential reasons but the exact mechanism for these benefits is still illusive.
authors.affiliation: Medizinische Klinik II, Medizinische Universität zu Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany.
authors.forename: Volkhard
authors.initials: V
authors.lastname: Kurowski
authors.forename: Evangelos
authors.initials: E
authors.lastname: Giannitsis
authors.forename: Dirk P
authors.initials: DP
authors.lastname: Killermann
authors.forename: Uwe K H
authors.initials: UK
authors.lastname: Wiegand
authors.forename: Ralph
authors.initials: R
authors.lastname: Toelg
authors.forename: Hendrik
authors.initials: H
authors.lastname: Bonnemeier
authors.forename: Franz
authors.initials: F
authors.lastname: Hartmann
authors.forename: Hugo A
authors.initials: HA
authors.lastname: Katus
authors.forename: Gert
authors.initials: G
authors.lastname: Richardt
mesh_terms: D000367:Age Factors; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods* / Q000401:mortality; D017023:Coronary Angiography; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy*; D015425:Myocardial Reperfusion / Q000379:methods*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors; D011379:Prognosis; D011446:Prospective Studies; D012907:Smoking / Q000009:adverse effects; D016896:Treatment Outcome; D020107:Troponin T / Q000378:metabolism
chemical_list: D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D020107:Troponin T