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Relationship between infarct artery location, epicardial flow, and myocardial perfusion after primary percutaneous revascularization in acute myocardial infarction.

Publication ,  Journal Article
Kandzari, DE; Tcheng, JE; Gersh, BJ; Cox, DA; Stuckey, T; Turco, M; Mehran, R; Garcia, E; Zimetbaum, P; McGlaughlin, MG; Lansky, AJ; Stone, GW ...
Published in: Am Heart J
June 2006

BACKGROUND: The association between infarct artery location, reperfusion success, and clinical outcomes after primary percutaneous coronary intervention (PCI) has not been characterized. We examined the infarct artery-specific impact of epicardial and myocardial flow and reperfusion after primary PCI for acute myocardial infarction. METHODS: Among 2082 patients undergoing primary PCI in the CADILLAC trial, myocardial blush grade, TIMI flow grade, ST-segment resolution, and clinical outcomes were analyzed according to the infarct artery. RESULTS: Baseline clinical characteristics did not significantly differ between patients experiencing infarction in the left anterior descending (LAD, 37%) versus left circumflex (18%) and right coronary artery (46%) distributions. Baseline left ventricular function was reduced, and collateral flow was less commonly present in patients with infarction involving the LAD. Achievement of final TIMI-3 flow, grade 3 myocardial blush, and ST-segment resolution >70% was also significantly less common in anterior infarction. Patients with anterior versus nonanterior infarction had significantly higher mortality at 30 days (3.4% vs 1.3%, P = .0006) and 1 year (6.5% vs 2.9%, P < .0001) and had increased 1-year rates of reinfarction (3.6% vs 1.7%, P = .009) and ischemic target vessel revascularization (16.1% vs 11.7%, P = .006). By multivariate analysis, LAD infarction was a powerful independent predictor of 1-year mortality (odds ratio 2.45, P = .009). CONCLUSIONS: Acute myocardial infarction involving the LAD distribution is associated with reduced left ventricular function, less frequent collateral flow, impaired myocardial perfusion and decreased reperfusion success, findings associated with reduced survival, and increased major adverse cardiac events compared with other vascular territories. These data provide mechanistic insights to the adverse prognosis of patients with anterior infarction.

Duke Scholars

Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

June 2006

Volume

151

Issue

6

Start / End Page

1288 / 1295

Location

United States

Related Subject Headings

  • Myocardial Infarction
  • Middle Aged
  • Male
  • Humans
  • Female
  • Coronary Circulation
  • Cardiovascular System & Hematology
  • Angioplasty, Balloon, Coronary
  • Aged
  • 3201 Cardiovascular medicine and haematology
 

Citation

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Kandzari, D. E., Tcheng, J. E., Gersh, B. J., Cox, D. A., Stuckey, T., Turco, M., … CADILLAC Investigators, . (2006). Relationship between infarct artery location, epicardial flow, and myocardial perfusion after primary percutaneous revascularization in acute myocardial infarction. Am Heart J, 151(6), 1288–1295. https://doi.org/10.1016/j.ahj.2005.08.017
Kandzari, David E., James E. Tcheng, Bernard J. Gersh, David A. Cox, Thomas Stuckey, Mark Turco, Roxana Mehran, et al. “Relationship between infarct artery location, epicardial flow, and myocardial perfusion after primary percutaneous revascularization in acute myocardial infarction.Am Heart J 151, no. 6 (June 2006): 1288–95. https://doi.org/10.1016/j.ahj.2005.08.017.
Kandzari, David E., et al. “Relationship between infarct artery location, epicardial flow, and myocardial perfusion after primary percutaneous revascularization in acute myocardial infarction.Am Heart J, vol. 151, no. 6, June 2006, pp. 1288–95. Pubmed, doi:10.1016/j.ahj.2005.08.017.
Kandzari DE, Tcheng JE, Gersh BJ, Cox DA, Stuckey T, Turco M, Mehran R, Garcia E, Zimetbaum P, McGlaughlin MG, Lansky AJ, Costantini CO, Grines CL, Stone GW, CADILLAC Investigators. Relationship between infarct artery location, epicardial flow, and myocardial perfusion after primary percutaneous revascularization in acute myocardial infarction. Am Heart J. 2006 Jun;151(6):1288–1295.
Journal cover image

Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

June 2006

Volume

151

Issue

6

Start / End Page

1288 / 1295

Location

United States

Related Subject Headings

  • Myocardial Infarction
  • Middle Aged
  • Male
  • Humans
  • Female
  • Coronary Circulation
  • Cardiovascular System & Hematology
  • Angioplasty, Balloon, Coronary
  • Aged
  • 3201 Cardiovascular medicine and haematology