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Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
[Association between post primary percutaneous coronary intervention myocardium reperfusion and prognosis in patients
Da-peng Zhang1, Yong-gui Ge, Le-feng Wang
1Heart Center, Chaoyang Hospital, Capital Medical University, Beijing 100020, China.
Insights
Poor reperfusion after primary percutaneous coronary intervention (PCI) in ST-elevation myocardial infarction (STEMI) patients is linked to worse outcomes. This includes higher rates of major adverse cardiac events during hospitalization and follow-up.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Outcomes Research
Context:
- Acute ST-elevation myocardial infarction (STEMI) requires prompt reperfusion therapy.
- Primary percutaneous coronary intervention (PCI) is the standard treatment for STEMI.
- Assessing reperfusion status post-PCI is crucial for patient management.
Purpose:
- To investigate the prognostic significance of reperfusion status after primary PCI in STEMI patients.
- To evaluate the association between ST segment resolution (STR) and TIMI myocardial perfusion grade (TMPG) and clinical outcomes.
- To identify risk factors for suboptimal reperfusion post-PCI.
Summary:
- A retrospective analysis of 964 STEMI patients treated with primary PCI was conducted.
- Patients were categorized based on ST segment resolution and TIMI myocardial perfusion grade.
- Poor reperfusion, indicated by low STR or TMPG, was observed in approximately one-third of patients.
Impact:
- Suboptimal reperfusion post-PCI is independently associated with increased in-hospital and follow-up major adverse cardiac events (MACE).
- Older age, cardiac dysfunction, diabetes, and delayed reperfusion are risk factors for poor reperfusion.
- Effective reperfusion is critical for improving outcomes in STEMI patients.
Objective:
To explore the prognostic impact of post primary percutaneous coronary intervention (PCI) reperfusion status on outcome in patients with acute ST-elevation myocardial infarction (STEMI).
Methods:
A retrospective analysis was performed in 964 patients undergoing primary PCI for STEMI. Electrocardiogram and TIMI myocardial perfusion grade (TMPG) were analyzed by reader blinded to the clinical course. Patients were divided to four groups according to ST segment resolution (STR) and TMPG: group A were patients with good STR and TMPG(425/964), group B were patients with poor STR and good TMPG (239/964), group C were patients with good STR and poor TMPG (113/964) and group D were patients with poor STR and TMPG (113/964).
Results:
Although TIMI grade III flow was achieved after mechanical reperfusion, abnormal reperfusion was still present in about 1/3 patients as shown by poor STR or TMPG. Older age, cardiac dysfunction and diabetes, prolonged time of pain to balloon/emergency room are independent risk factors for abnormal reperfusion post PCI. Major adverse cardiac events events in hospital (RR = 64. 63, P < 0.01) and during follow up (RR = 11.69, P < 0.01) were significantly higher in group D than in group A.
Conclusion:
Poor post PCI reperfusion status is associated with higher in hospital and during follow up major adverse cardiac events event in STEMI patients.
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