Comparative predictive value of infarct location, peak CK, and ejection fraction after primary PCI for ST elevation myocardial infarction.
OBJECTIVE
Although infarct location may predict prognosis after primary percutaneous coronary intervention (PCI) for ST elevation myocardial infarction, previous studies were powered insufficiently to be able to show whether this association is independent of peak creatine kinase (CK) or left ventricular ejection fraction (LVEF).


METHODS
A large-scale, prospective, observational, single-center study was performed including all patients who underwent primary PCI between 1991 and 2004 in Zwolle (The Netherlands). The association between infarct location and 1-year outcome, was compared with the prognostic impact of peak CK and LVEF.


RESULTS
Of 4990 patients, 2485 (49.8%) had an anterior infarction. Patients with anterior myocardial infarction had a higher peak CK (2960 vs. 2009 U/l, P<0.001) and a lower LVEF (40.0 vs. 50.0%, P<0.001). Mortality within 1 year was higher in patients with anterior infarction as well as in those with a high peak CK or a low LVEF. After multivariate analyses, patients with anterior infarction still had an increased risk of a high peak CK, a poor LVEF, and also a higher 1-year mortality, odds ratio (OR) 1.35 [95% confidence interval (CI) 1.07-1.70]. Low LVEF was a significant stronger predictor of 1-year mortality, OR 4.4 (95% CI: 2.4-7.8), compared with peak CK, OR 2.0 (95% CI: 1.6-2.5) or anterior location, OR 1.6 (95% CI: 1.3-2.0).


CONCLUSIONS
In patients undergoing primary PCI, location of infarction is an important independent predictor of high peak CK, low LVEF, and increased mortality. LVEF is a strong predictor of 1-year mortality.
Nienhuis
Mark B
MB
Department of Cardiology, Isala klinieken, Locatie Weezenlanden, Zwolle, The Netherlands.
Ottervanger
Jan Paul
JP
Dambrink
Jan-Henk E
JH
de Boer
Menko-Jan
MJ
Hoorntje
Jan C A
JC
Gosselink
A T Marcel
AT
Suryapranata
Harry
H
van 't Hof
Arnoud W J
AW
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000401:mortality; D015415:Biomarkers / Q000097:blood; D003402:Creatine Kinase / Q000097:blood*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000201:enzymology / Q000401:mortality / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D009206:Myocardium / Q000473:pathology*; D009426:Netherlands; D016017:Odds Ratio; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left; D055815:Young Adult
D015415:Biomarkers; D003402:Creatine Kinase