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
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.