Predictors of in-hospital prognosis after primary percutaneous coronary intervention for acute myocardial infarction requiring mechanical support devices.
BACKGROUND
Predictors of in-hospital outcome after primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) requiring mechanical support devices such as intra-aortic balloon pumping (IABP) and/or percutaneous cardiopulmonary support (PCPS) 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 requiring mechanical assist devices (with-IABP/PCPS patients, n=275) and those without (without-IABP/PCPS patients, n=1,510). The with-IABP/PCPS patients were more likely to have a larger number of diseased vessels, lower Thrombolysis In Myocardial Infarction (TIMI) grade in the infarct-related artery (IRA) before/after primary PCI, and a significantly higher in-hospital mortality rate than the without-IABP/PCPS patients. On multivariate analysis, the number of diseased vessels > or =2 or diseased left main trunk (LMT) at initial coronary angiography (CAG) was the independent positive predictor of the in-hospital mortality in the with-IABP/PCPS patients, not in the without-IABP/PCPS patients, whereas acquisition of TIMI 3 flow in the IRA immediately after primary PCI was the negative predictor in the without-IABP/PCPS patients, not in the with-IABP/PCPS patients.


CONCLUSIONS
The number of diseased vessels > or =2 or diseased LMT at initial CAG is an independent risk factor of in-hospital death in primary PCI-treated AMI patients requiring mechanical support devices.
Shiraishi
Jun
J
Department of Cardiology, Kyoto First Red Cross Hospital, Kyoto, Japan. sjun@msj.biglobe.ne.jp
Kohno
Yoshio
Y
Sawada
Takahisa
T
Kimura
Masayoshi
M
Ariyoshi
Makoto
M
Matsui
Akihiro
A
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
Kitamura
Makoto
M
Furukawa
Keizo
K
Matsubara
Hiroaki
H
D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D001243:Assisted Circulation / Q000379:methods* / Q000706:statistics & numerical data; D001808:Blood Vessels / Q000473:pathology; D017023:Coronary Angiography; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D016896:Treatment Outcome