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Contribution of angiographic and electrocardiographic parameters of reperfusion to prediction of mortality and morbidity after acute ST-elevation myocardial infarction: Insights from the Assessment of Pexelizumab in Acute Myocardial Infarction trial.

Publication ,  Journal Article
Brener, SJ; Westerhout, CM; Fu, Y; Todaro, TG; Moliterno, DJ; Wagner, GS; Granger, CB; Armstrong, PW; APEX-AMI Investigators,
Published in: Am Heart J
November 2009

BACKGROUND: Reperfusion with primary percutaneous intervention (PCI) in ST-segment elevation myocardial infarction leads to improved clinical outcomes. The contribution angiographic vs electrocardiographic reperfusion parameters confer on prognosis is unclear. METHODS: A prespecified subset of the APEX-AMI trial patients was analyzed by independent angiographic and electrocardiographic core laboratories (n = 1,018). Angiographic reperfusion after PCI and electrocardiogram 30 minutes post-PCI were assessed. RESULTS: Of the 941 patients in the angiographic substudy, 796 (85%) attained post-PCI Thrombolysis In Myocardial Infarction (TIMI) flow 3 and 852 (91%) had TIMI Myocardial Perfusion Grade (TMPG) 2/3. There were 664 (71%) patients with residual ST elevation (ST-E) <2 mm. Ninety-day mortality and death/CHF/shock were lower in patients with TIMI flow 3 vs <3 (1.9% vs 6.2%, P = .002; 5.8% vs 10.4%, P = .044) and those with TMPG 2/3 vs 0/1 (2.0% vs 7.9%, P = .001; 6.0% vs 11.9%, P = .028). Patients with residual ST-E <2 mm had similar rates of mortality as those with > or =2 mm (2.3% vs 3.3%, P = .374) but lower rates of death/CHF/shock (5.2% vs 9.6%, P = .013). After multivariable adjustment, only post-PCI TMPG 2/3 was significantly associated with survival (P = .001), whereas residual ST-E (P = .606) and post-PCI TIMI flow grade (P = .086) were not. Conversely, residual ST-E > or =2 mm (P = .012) rather than angiographic reperfusion was associated with the composite of death/CHF/shock events. CONCLUSION: Angiographic and electrocardiographic estimates of reperfusion with primary PCI in ST-segment elevation myocardial infarction provide different and complementary predictions of morbidity and mortality.

Duke Scholars

Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

November 2009

Volume

158

Issue

5

Start / End Page

755 / 760

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Predictive Value of Tests
  • Myocardial Reperfusion
  • Myocardial Infarction
  • Middle Aged
  • Male
  • Humans
  • Female
  • Electrocardiography
  • Coronary Angiography
 

Citation

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MLA
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Brener, S. J., Westerhout, C. M., Fu, Y., Todaro, T. G., Moliterno, D. J., Wagner, G. S., … APEX-AMI Investigators, . (2009). Contribution of angiographic and electrocardiographic parameters of reperfusion to prediction of mortality and morbidity after acute ST-elevation myocardial infarction: Insights from the Assessment of Pexelizumab in Acute Myocardial Infarction trial. Am Heart J, 158(5), 755–760. https://doi.org/10.1016/j.ahj.2009.09.009
Brener, Sorin J., Cynthia M. Westerhout, Yuling Fu, Thomas G. Todaro, David J. Moliterno, Galen S. Wagner, Christopher B. Granger, Paul W. Armstrong, and Paul W. APEX-AMI Investigators. “Contribution of angiographic and electrocardiographic parameters of reperfusion to prediction of mortality and morbidity after acute ST-elevation myocardial infarction: Insights from the Assessment of Pexelizumab in Acute Myocardial Infarction trial.Am Heart J 158, no. 5 (November 2009): 755–60. https://doi.org/10.1016/j.ahj.2009.09.009.
Journal cover image

Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

November 2009

Volume

158

Issue

5

Start / End Page

755 / 760

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Predictive Value of Tests
  • Myocardial Reperfusion
  • Myocardial Infarction
  • Middle Aged
  • Male
  • Humans
  • Female
  • Electrocardiography
  • Coronary Angiography