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Published on: December 11, 2016
Comparative predictive value of infarct location, peak CK, and ejection fraction after primary PCI for ST elevation
Mark B Nienhuis1, Jan Paul Ottervanger, Jan-Henk E Dambrink
1Department of Cardiology, Isala klinieken, Locatie Weezenlanden, Zwolle, The Netherlands.
Insights
Infarct location is an independent predictor of outcomes after primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction. Left ventricular ejection fraction (LVEF) is a stronger predictor of 1-year mortality than peak creatine kinase (CK).
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Outcomes Research
Background:
- Prognosis after primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) is influenced by infarct location.
- Previous studies lacked sufficient power to determine if infarct location's prognostic value is independent of peak creatine kinase (CK) or left ventricular ejection fraction (LVEF).
Purpose of the Study:
- To investigate whether infarct location is an independent predictor of prognosis after primary PCI for STEMI.
- To compare the prognostic impact of infarct location with peak CK and LVEF on 1-year mortality.
Main Methods:
- A large-scale, prospective, observational, single-center study included 4990 patients undergoing primary PCI between 1991 and 2004.
- The association between infarct location and 1-year outcome was analyzed and compared with the prognostic impact of peak CK and LVEF using multivariate analyses.
Main Results:
- Anterior myocardial infarction (49.8% of patients) was associated with higher peak CK and lower LVEF.
- Anterior infarction remained an independent predictor of high peak CK, low LVEF, and increased 1-year mortality (OR 1.35).
- Low LVEF was a stronger predictor of 1-year mortality (OR 4.4) compared to peak CK (OR 2.0) or anterior infarct location (OR 1.6).
Conclusions:
- Infarct location is an important independent predictor of high peak CK, low LVEF, and increased mortality in patients undergoing primary PCI.
- Left ventricular ejection fraction (LVEF) is a significant and strong predictor of 1-year mortality following primary PCI for STEMI.
Objective:
Although infarct location may predict prognosis after primary percutaneous coronary intervention (PCI) for ST elevation myocardial infarction, previous studies were powered insufficiently to be able to show whether this association is independent of peak creatine kinase (CK) or left ventricular ejection fraction (LVEF).
Methods:
A large-scale, prospective, observational, single-center study was performed including all patients who underwent primary PCI between 1991 and 2004 in Zwolle (The Netherlands). The association between infarct location and 1-year outcome, was compared with the prognostic impact of peak CK and LVEF.
Results:
Of 4990 patients, 2485 (49.8%) had an anterior infarction. Patients with anterior myocardial infarction had a higher peak CK (2960 vs. 2009 U/l, P<0.001) and a lower LVEF (40.0 vs. 50.0%, P<0.001). Mortality within 1 year was higher in patients with anterior infarction as well as in those with a high peak CK or a low LVEF. After multivariate analyses, patients with anterior infarction still had an increased risk of a high peak CK, a poor LVEF, and also a higher 1-year mortality, odds ratio (OR) 1.35 [95% confidence interval (CI) 1.07-1.70]. Low LVEF was a significant stronger predictor of 1-year mortality, OR 4.4 (95% CI: 2.4-7.8), compared with peak CK, OR 2.0 (95% CI: 1.6-2.5) or anterior location, OR 1.6 (95% CI: 1.3-2.0).
Conclusion:
In patients undergoing primary PCI, location of infarction is an important independent predictor of high peak CK, low LVEF, and increased mortality. LVEF is a strong predictor of 1-year mortality.
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