Predictors of nonoptimal coronary flow after primary percutaneous coronary intervention with stent implantation for acute myocardial infarction.
BACKGROUND
Predictors of suboptimal coronary flow in the infarct-related artery (IRA) after stent-based primary percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI) have not been fully investigated.


RESULTS
Using the AMI-Kyoto Multi-Center Risk Study database, we retrospectively compared clinical manifestations and in-hospital prognosis between AMI patients undergoing stent-based primary PCI with final Thrombolysis In Myocardial Infarction (TIMI) grade < or = 2 in the IRA (nonoptimal group, n=69) and those with final TIMI grade 3 (optimal group, n=1200). The nonoptimal group had higher prevalence of Killip class > or = 3 at admission, higher frequency of mechanical support devices during procedures, larger value of maximal creatine phosphokinase, and a significantly higher in-hospital mortality rate (27.5% for nonoptimal vs. 9.0% for optimal, P<0.001), compared with the optimal group. On multivariate analysis, Killip class > or = 3 at admission was the independent predictor of the final nonoptimal flow (odds ratio 2.33, 95% confidence intervals 1.27-4.26 P=0.006), but TIMI 3 flow before primary PCI and elapsed time (symptom onset-to-admission time)<24h were not.


CONCLUSIONS
Killip class > or = 3 at admission is an independent predictor of the final nonoptimal flow in AMI patients undergoing primary PCI with stent implantation.
Shiraishi
Jun
J
Department of Cardiology, Kyoto First Red Cross Hospital, 15-749 Honmachi, Higashiyama-ku, Kyoto 605-0981, Japan. sjun@msj.biglobe.ne.jp
Kohno
Yoshio
Y
Sawada
Takahisa
T
Takeda
Mitsuo
M
Arihara
Masayasu
M
Hyogo
Masayuki
M
Shima
Takatomo
T
Okada
Takashi
T
Nakamura
Takeshi
T
Matoba
Satoaki
S
Yamada
Hiroyuki
H
Matsumuro
Akiyoshi
A
Shirayama
Takeshi
T
Kitamura
Makoto
M
Furukawa
Keizo
K
Matsubara
Hiroaki
H
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D017023:Coronary Angiography; D003326:Coronary Circulation / Q000502:physiology*; D003402:Creatine Kinase / Q000097:blood; D005260:Female; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D015425:Myocardial Reperfusion; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents
D003402:Creatine Kinase