Prediction of long-term outcome after primary percutaneous coronary intervention for acute anterior myocardial infarction.
BACKGROUND
Despite the widespread use of reperfusion methods, the long-term outcome after primary percutaneous coronary intervention (PCI) is variable, and accurate risk stratification is of clinical importance.


OBJECTIVE
To assess the predictors of long term outcome after PCI for acute anterior myocardial infarction (AMI).


METHODS
One hundred and twenty-seven consecutive patients undergoing PCI within 12 hours from the onset of the first AMI were enrolled. Troponin I, CK-MB, creatinine, NT-proBNP, echocardiographic left ventricular (LV) function, myocardial contrast perfusion, results of coronary angiography, ECG, 24-hour Holter ECG, and T-wave alternans (TWA) were analysed as predictors of major adverse cardiac events (MACE), defined as death, non-fatal reinfarction, sustained ventricular tachycardia, and rehospitalisation for decompensated heart failure. Patients were followed up for two years.


RESULTS
Twenty-seven patients developed MACE. The best predictive model for MACE consisted of impaired perfusion (MCE, myocardial contrast echocardiography), higher CK-MB at 24 hours, discharge NT-proBNP, and non-negative TWA. The combination of elevated creatinine level, decreased LV ejection fraction, and a non-negative TWA proved the best for identification of patients at risk of cardiac death. The best multivariate model for predicting heart failure hospitalisation consisted of higher 24-hour CK-MB, discharge NT-proBNP, impaired perfusion and prolonged duration of ST elevation.


CONCLUSIONS
Our study showed that the rate of MACE in patients with anterior ST-segment elevation myocardial infarction undergoing primary PCI at two years follow-up is low. A combined assessment of myocardial contrast perfusion, TWA, CK-MB and discharge NT-proBNP seems to optimally predict patients at risk of MACE.
Wita
Krystian
K
Department of Cardiology, Medical University of Silesia, Katowice, Poland.
Filipecki
Artur
A
Szydło
Krzysztof
K
Turski
Maciej
M
Tabor
Zbigniew
Z
Wróbel
Wojciech
W
Elzbieciak
Marek
M
Lelek
Michał
M
Bochenek
Tomasz
T
Trusz-Gluza
Maria
M
D000792:Angiography; D015906:Angioplasty, Balloon, Coronary; D018572:Disease-Free Survival; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000628:therapy*; D011379:Prognosis; D011446:Prospective Studies; D016896:Treatment Outcome