Beneficial effect of reperfusion therapy beyond the preservation of left ventricular function in patients with acute ST-segment elevation myocardial infarction.
BACKGROUND
Reperfusion therapy has been shown to improve mortality in patients with acute ST-segment elevation myocardial infarction. However, in randomized clinical trials there was only a modest improvement in left ventricular ejection fraction with reperfusion therapy, despite a larger improvement in mortality.


METHODS
In the prospective MITRA-Plus registry we compared 1-year mortality of inhospital survivors of ST-segment elevation myocardial infarction (STEMI) divided into nine groups with preserved (>55%), moderately reduced (41-55%) and severely reduced (≤40%) left ventricular ejection fraction (LVEF) and treated with no early reperfusion therapy, fibrinolysis or primary percutaneous coronary intervention (PCI) within 24 h after admission.


RESULTS
A total of 5867 patients were included in this analysis, 1026 (18%) without early reperfusion, 2462 (42%) with fibrinolysis and 2379 (40%) with primary PCI. After adjustment for confounding variables in a propensity score analysis, reperfusion therapy (Odds ratio and 95% CI: 0.27, 0.15-0.48; 0.50, 0.32-0.79; 0.64, 0.44-0.93), fibrinolysis (Odds ratio and 95% CI: 0.27, 0.14-0.52; 0.58, 0.35-0.95; 0.60, 0.39-0.93) and primary PCI (Odds ratio and 95% CI: 0.22, 0.11-0.44; 0.34, 0.19-0.59; 0.56, 0.36-0.88) remained independent predictors of survival in comparison to no reperfusion therapy in the patients with preserved, moderately reduced and severely reduced LVEF, respectively.


CONCLUSIONS
These results suggest a beneficial effect of early reperfusion therapy beyond the preservation of left ventricular function, however the mechanisms need further study.
Zeymer
Uwe
U
Herzzentrum Ludwigshafen, Medizinische Klink B, Ludwigshafen, Germany. Uwe.Zeymer@t-online.de
Bauer
Timm
T
Gersh
Bernard J
BJ
Zahn
Ralf
R
Gitt
Anselm
A
Jünger
Claus
C
Senges
Jochen
J
D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000401:mortality*; D004562:Electrocardiography; D005260:Female; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality* / Q000628:therapy*; D011379:Prognosis; D012042:Registries / Q000706:statistics & numerical data; D013318:Stroke Volume; D016277:Ventricular Function, Left