Predictors of in-hospital outcome after primary percutaneous coronary intervention for recurrent myocardial infarction.
BACKGROUND
Recurrent acute myocardial infarction (AMI) is a deteriorated condition with high in-hospital morbidity and mortality, but the predictors of in-hospital outcome after primary percutaneous coronary intervention (PCI) for repeat AMI remain unclear.


RESULTS
Using the AMI-Kyoto Multi-Center Risk Study database, clinical background, angiographic findings, results of primary PCI, and in-hospital prognosis were retrospectively compared between primary PCI-treated AMI patients with previous myocardial infarction (MI) (repeat-MI patients, n=235) and those without previous MI (first-MI patients, n=1,550). The repeat-MI patients had higher prevalence of Killip class>or=3 at admission, larger number of diseased vessels, and a significantly higher in-hospital mortality rate than the first-MI patients. On multivariate analysis, number of diseased vessels>or=2 or diseased left main trunk (LMT) on initial coronary angiography was the independent positive predictor of in-hospital mortality in the repeat-MI patients, not in the first-MI patients, whereas acquisition of Thrombolysis In Myocardial Infarction 3 flow in the infarct-related artery immediately after primary PCI and elapsed time<24 h were the negative predictors in the first-MI patients, not in the repeat-MI patients.


CONCLUSIONS
Number of diseased vessels>or=2 or diseased LMT on initial coronary angiography is an independent risk factor of in-hospital death in recurrent-AMI patients undergoing primary PCI.
Shiraishi
Jun
J
Department of Cardiology, Kyoto First Red Cross Hospital, and Department of Cardiology and Vascular Regenerative Medicine, Kyhoto Prefectural University School of Medicine, Kyoto, Japan. sjun@msj.biglobe.ne.jp
Kohno
Yoshio
Y
Sawada
Takahisa
T
Takeda
Mitsuo
M
Arihara
Masayasu
M
Hyogo
Masayuki
M
Yagi
Takakazu
T
Shima
Takatomo
T
Okada
Takashi
T
Nakamura
Takeshi
T
Matoba
Satoaki
S
Yamada
Hiroyuki
H
Shirayama
Takeshi
T
Kitamura
Makoto
M
Furukawa
Keizo
K
Matsubara
Hiroaki
H
D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000150:complications* / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D003326:Coronary Circulation; D016208:Databases, Factual; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome