Reperfusion after primary angioplasty for ST-elevation myocardial infarction: predictors of success and relationship to clinical outcomes in the APEX-AMI angiographic study.

Abstract

AIMS:

We studied the clinical, demographic, and angiographic factors associated with successful reperfusion and the relationship between angiographic indices and clinical outcomes in a subset of the APEX-AMI trial, which tested the efficacy of pexelizumab in ST-elevation myocardial infarction patients undergoing primary percutaneous coronary intervention (PCI).

METHODS AND RESULTS:

Among 5745 patients enrolled in the trial, 1018 underwent independent quantitative angiographic evaluation by a core laboratory. Successful epicardial reperfusion was defined as TIMI (thrombolysis in myocardial infarction) flow grade 3 or corrected TIMI frame count (cTFC) <28 frames, and successful myocardial reperfusion as TIMI myocardial perfusion grade (TMPG) 2 or 3. TIMI 3 flow after PCI occurred in 85%, cTFC < 28 in 58% (mean cTFC was 27 +/- 20), and TMPG 2 or 3 in 91%. Overall 90 day clinical outcomes were 2.7% for mortality and 8.2% for the composite of death, congestive heart failure (CHF), or shock. After adjustment for baseline characteristics, TMPG 2/3 after PCI was associated with younger age [odds ratio (OR) for 10 year increase 0.75, 95% confidence interval (CI) 0.59-0.96, P = 0.023], pre-PCI TIMI flow 2/3 (OR 3.5, 95% CI 1.7-7.1, P = 0.001), and ischaemic time [for every hour, OR 0.81 (0.69-0.96), P = 0.015]. TMPG 2/3 after PCI was significantly associated with 90 day mortality (adjusted hazard ratio 0.26, 95% CI 0.09-0.78, P = 0.013). Neither post-PCI TMPG nor TIMI flow grade was significantly associated with 90 day death/CHF/shock.

CONCLUSION:

Younger age, patent infarct-related artery at presentation, and ischaemic time predicted higher likelihood of successful myocardial perfusion, which was associated with improved survival.

• Authors: Sorin J Brener, David J Moliterno, Philip E Aylward, Arnoud W J van't Hof, Witold Ruźyllo, William W O'Neill, Christian W Hamm, Cynthia M Westerhout, Christopher B Granger, Paul W Armstrong, APEX-AMI Investigators
• Journal: European heart journal (Eur Heart J) Vol. 29 Issue 9 Pg. 1127-35 (May 2008) ISSN: 0195-668X [Print] England
• PMID: 18375399 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Antibodies, Monoclonal
• Antibodies, Monoclonal, Humanized
• Single-Chain Antibodies
• pexelizumab

Topics

• Aged
• Angioplasty, Balloon, Coronary (methods, mortality)
• Antibodies, Monoclonal (therapeutic use)
• Antibodies, Monoclonal, Humanized
• Cohort Studies
• Coronary Angiography (methods)
• Female
• Humans
• Male
• Middle Aged
• Myocardial Infarction (diagnostic imaging, mortality, therapy)
• Myocardial Reperfusion (methods, mortality)
• Predictive Value of Tests
• Single-Chain Antibodies
• Survival Analysis
• Treatment Outcome