title: Impact of multivessel disease on myocardial perfusion and survival among patients undergoing primary percutaneous coronary intervention with glycoprotein IIb/IIIa inhibitors.
abstract: BACKGROUND
  Although primary angioplasty achieves thrombolysis in myocardial infarction (TIMI) 3 flow in most patients with ST-elevation myocardial infarction, epicardial recanalization does not guarantee optimal perfusion in a large proportion of patients. The influence of multivessel disease on myocardial reperfusion and survival after primary angioplasty has not been extensively investigated.
  
  
  OBJECTIVE
  To evaluate the impact of multivessel disease on myocardial perfusion and survival in a large cohort of patients with ST-elevation myocardial infarction treated with angioplasty and glycoprotein (GP) IIb/IIIa inhibitors.
  
  
  METHODS
  This analysis is based on 1494 patients undergoing primary angioplasty included in the EGYPT database. Myocardial perfusion was evaluated by angiography or ST-segment resolution, whereas infarct size was estimated by using peak creatine kinase-MB (CK-MB). Follow-up data were collected between 30 days and 1 year after primary angioplasty.
  
  
  RESULTS
  Multivessel disease was observed in 870 patients (58.2%). The extent of coronary artery disease was associated with age, diabetes, hypertension, previous myocardial infarction, previous revascularization, abciximab treatment and longer ischaemic time, and was independently associated with impaired angiographic myocardial perfusion (adjusted odds ratio 1.18, 95% confidence interval [CI] 1.01-1.40, P=0.049). At 208±160 days, the extent of coronary artery disease was independently associated with higher mortality (adjusted hazard ratio 1.54, 95% CI 1.06-2.24, P=0.022).
  
  
  CONCLUSIONS
  Among patients with ST-elevation myocardial infarction undergoing primary angioplasty with GP IIb/IIIa inhibitor treatment, the extent of coronary artery disease was independently associated with impaired myocardial perfusion and survival.
authors.affiliation: Division of Cardiology, "Maggiore della Carità" Hospital, Eastern Piedmont University, Novara, Italy. giuseppe.deluca@maggioreosp.novara.it
authors.forename: Giuseppe
authors.initials: G
authors.lastname: De Luca
authors.forename: Michael
authors.initials: M
authors.lastname: Gibson
authors.forename: Donald
authors.initials: D
authors.lastname: Cutlip
authors.forename: Kurt
authors.initials: K
authors.lastname: Huber
authors.forename: Dariusz
authors.initials: D
authors.lastname: Dudek
authors.forename: Francesco
authors.initials: F
authors.lastname: Bellandi
authors.forename: Marko
authors.initials: M
authors.lastname: Noc
authors.forename: Mauro
authors.initials: M
authors.lastname: Maioli
authors.forename: Simona
authors.initials: S
authors.lastname: Zorman
authors.forename: Uwe
authors.initials: U
authors.lastname: Zeymer
authors.forename: Gioel Gabrio
authors.initials: GG
authors.lastname: Secco
authors.forename: Henrique
authors.initials: H
authors.lastname: Mesquita Gabriel
authors.forename: Ayse
authors.initials: A
authors.lastname: Emre
authors.forename: Hans-Richard
authors.initials: HR
authors.lastname: Arntz
authors.forename: Tomasz
authors.initials: T
authors.lastname: Rakowski
authors.forename: Maryann
authors.initials: M
authors.lastname: Gyongyosi
authors.forename: Arnoud W J Van't
authors.initials: AW
authors.lastname: Hof
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000097:blood / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D003326:Coronary Circulation; D052279:Creatine Kinase, MB Form / Q000097:blood; D005060:Europe; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D055414:Myocardial Perfusion Imaging / Q000379:methods; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000401:mortality; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors*; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D052279:Creatine Kinase, MB Form