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Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
Unsuccessful reperfusion in patients with ST-segment elevation myocardial infarction treated by primary angioplasty
Giuseppe De Luca1, Arnoud W J van 't Hof, Jan Paul Ottervanger
1Department of Cardiology, ISALA Klinieken De Weezenlanden Hospital, 8011 JW Zwolle, The Netherlands.
Insights
Optimal myocardial perfusion after primary angioplasty for ST-segment elevation myocardial infarction (STEMI) is crucial. Poor reperfusion, identified by myocardial blush grade, significantly increases 1-year mortality risk in STEMI patients.
Area of Science:
- Cardiology
- Interventional Cardiology
- Myocardial Perfusion Imaging
Background:
- Epicardial vessel patency alone does not ensure adequate myocardial perfusion post-primary angioplasty for STEMI.
- Assessing myocardial perfusion is critical for predicting outcomes in STEMI patients.
Purpose of the Study:
- To identify clinical and angiographic predictors of unsuccessful myocardial reperfusion using myocardial blush grade in STEMI patients.
- To evaluate the impact of poor myocardial reperfusion on 1-year mortality.
Main Methods:
- Analysis of 1,548 consecutive STEMI patients treated with primary angioplasty.
- Prospective collection of clinical and angiographic data.
- Definition of successful reperfusion: postprocedural TIMI 3 flow with myocardial blush grades 2-3.
Main Results:
- Poor myocardial reperfusion occurred in 23.1% of patients, associated with larger infarct size and lower ejection fraction.
- Independent predictors of poor reperfusion included preprocedural TIMI flow 0-1, anterior infarction, ischemic time, residual stenosis, advanced Killip class, and age.
- Unsuccessful reperfusion independently predicted a 3.11-fold increased risk of 1-year mortality.
Conclusions:
- High prevalence of poor myocardial reperfusion in STEMI patients undergoing primary angioplasty.
- Poor reperfusion significantly impacts 1-year mortality.
- Identifying and targeting high-risk patients with improved reperfusion strategies is essential.
Background:
Several studies have shown that patency of the epicardial vessel does not guarantee optimal myocardial perfusion in patients undergoing primary angioplasty for ST-segment elevation myocardial infarction (STEMI). The aim of the current study was to identify clinical and angiographic correlates of unsuccessful reperfusion by the use of myocardial blush grade in a large consecutive cohort of STEMI patients.
Methods:
Our population is represented by a total of 1,548 consecutive patients with STEMI treated by primary angioplasty at our institution. All clinical and angiographic data were prospectively collected. Successful reperfusion was defined as postprocedural thrombolysis in myocardial infarction (TIMI) 3 flow with myocardial blush grades 2 to 3.
Results:
Poor myocardial reperfusion was observed in 358 patients (23.1%) and was associated with a significantly larger infarct size (1838 [350-3387] vs 1187 [607-2257], P < .0001) and lower ejection fraction (41 [31-48.2] vs 65 [36.5-52.5] P < .0001). At multivariate analysis, preprocedural TIMI flow 0 to 1, anterior infarction, ischemic time, postprocedural residual stenosis, advanced Killip class at presentation, and age were identified as independent predictors of poor myocardial reperfusion. At 1-year follow-up, a total of 92 patients (5.9%) had died. At multivariate analysis, including clinical and angiographic variables, unsuccessful reperfusion was an independent predictor of 1-year mortality (relative risk 3.11, 95% CI 1.99-4.87, P < .0001).
Conclusions:
The prevalence of poor myocardial reperfusion is relatively high in patients undergoing primary angioplasty for STEMI, with a significant impact on 1-year mortality. Preprocedural TIMI flow, anterior infarction, ischemic time, Killip class at presentation, and age were independently associated with unsuccessful reperfusion. Future research should be focused on these high-risk patients, and treatment strategies should be developed to improve myocardial perfusion and clinical outcome.
