Interv Akut Kardiol. 2002;1(1):21-27

Influence of infarct related artery reperfusion before primary coronary angioplasty

Stanislav Šimek¹, Michael Aschermann¹, František Holm², Jiří Humhal¹, Aleš Linhart¹, Miroslav Pšenička¹, Libor Hemžský¹, Jan Vojáček^3,4

¹ II. interní klinika kardiologie a angiologie 1. LF UK a VFN, Praha

² Kardiologické oddělení, Krajská nemocnice Liberec

³ I. interní klinika Fakultní nemocnice v Hradci Králové

⁴ Kardiocentrum dospělých, oddělení invazivní kardiologie interní kliniky 2. LF UK a FN Motol, Praha

Objectives: To investigate the prevalence of total coronary occlusion during the early hours of acute myocardial infarction (AMI). To evaluate the effect of infarct artery reperfusion before primary coronary angioplasty on short-term and long-term prognosis of patients with AMI.

Methods: 278 consecutive patients with AMI treated with primary coronary angioplasty were followed for 38 ± 12 months. The study population was divided into 2 groups according to the presence (group A, n = 33) or absence (group B, n = 245) of infarct related artery TIMI (Thrombolysis In Myocardial Infarction) flow ≥ 2 on the preintervention angiogram. The occurrence of reinfarction, congestive heart failure, coronary arteries reintervention and death during follow-up were investigated.

Results: Baseline characteristics were similar between the 2 groups. More patient in group B had cardiogenic shock (11 % vs. 0 %, p = 0,045). Success rate of primary PTCA (ability to achieve TIMI ≥ 2 ) was higher in group A (100 % vs. 89,4 %, p = 0,046). Ejection fraction of left ventricle was insignificantly higher in group A (52 % vs. 47 %, ns), peak levels of creatine kinase were lower in group A (20 ± 21 vs. 38 ± 29 µkat/l, ns). In group A there was a trend to lower 30 day mortality (0 % vs. 7,8 %, p = 0,09), lower need to urgent repeated coronary angioplasty (0 % vs.8,6 %, p = 0,08) within 30 days. Congestive heart failure within 30 days was more frequent ( 22,9 % vs. 6,1 %, p = 0,026) and long-term mortality was higher (17,1 % vs. 3 %, p = 0,037) in group B.

Conclusions: Prevalence of infarct related artery reperfusion before primary angioplasty in our population was lower compared to previous studies. Reperfusion of infarct related artery before primary coronary angioplasty is associated with higher procedure success rate, smaller infarct size, lower incidence of congestive heart failure, lower need of urgent revascularization and lower long term mortality.

Keywords: primary angioplasty, reperfusion before intervention.

Published: December 31, 2002  Show citation