Predictors of long-term outcomes following direct percutaneous coronary intervention for acute myocardial infarction

Citation
N. Beohar et al., Predictors of long-term outcomes following direct percutaneous coronary intervention for acute myocardial infarction, AM J CARD, 88(10), 2001, pp. 1103-1107
Citations number
22
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Cardiovascular & Respiratory Systems","Cardiovascular & Hematology Research
Journal title
AMERICAN JOURNAL OF CARDIOLOGY
ISSN journal
0002-9149 → ACNP
Volume
88
Issue
10
Year of publication
2001
Pages
1103 - 1107
Database
ISI
SICI code
0002-9149(20011115)88:10<1103:POLOFD>2.0.ZU;2-W
Abstract
To determine predictors of a long-term major adverse cardiac event (MACE) i n unselected patients undergoing direct percutaneous coronary intervention (PCI), 274 consecutive patients presenting within 12 hours of ST-segment el evation acute myocardial infarction (MI) were evaluated. No patient with ST -segment elevation AMI received intravenous thrombolytic drugs. Chest pain to balloon time was 3.8 hours (range 2.5 to 6.9). percutaneous transluminal coronary angioplasty was successful in 95% of patients. Abciximab was admi nistered to 69% of patients, stents were deployed in 53%, and 17% underwent only catheterization. In-hospital events were death (7%), abrupt closure ( 2%), emergent coronary artery bypass grafting (CABG) (5%), repeat PCI (3%), and recurrent myocardial infarction (1%). In patients undergoing direct PC I (=227), the in-hospital event rate was death 5.3%, abrupt closure 2.2%, e mergency CABG 0.9%, repeat PCI 3.1%, and repeat myocardial infarction 1.3%. Median time to last follow-up or death was 20 months (range 11 to 34), and to any event, 0.3 months (range 0.03 to 24.0). Postdischarge MACE included death (5%), AMI (4%), repeat PCI (8%), CABG (9%), and stroke (0.7%). Among those undergoing direct PCI (n=227), 10% died, 3.5% had a repeat AMI, 9% h ad a repeat PCI, 5% had CABG, and 1% had a stroke at long-term follow-up. A t long-term follow-up, 75% were event free. Multivariate predictors were (h azard ratio [95% confidence interval (CI)]): abciximab use 0.6 (95% CI 0.43 to 0.95), Killip class 2.2 (95% CI 1.1 to 4.4), and number of narrowed cor onary arteries 1.7 (95% CI 1.4 to 2.2). In this unselected consecutive seri es of patients presenting with ST-segment elevation AMI, direct PCI was ass ociated with sustained long-term efficacy. Outcomes were predicted by cardi ac impairment at presentation and number of narrowed coronary arteries. MAC E is not related to device selection but is significantly improved with abc iximab. (C) 2001 by Excerpta Medica, Inc.