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Reperfusion after primary angioplasty for ST-elevation myocardial infarction: predictors of success and relationship to clinical outcomes in the APEX-AMI angiographic study.

Publication ,  Journal Article
Brener, SJ; Moliterno, DJ; Aylward, PE; van't Hof, AWJ; Ruźyllo, W; O'Neill, WW; Hamm, CW; Westerhout, CM; Granger, CB; Armstrong, PW ...
Published in: Eur Heart J
May 2008

AIMS: We studied the clinical, demographic, and angiographic factors associated with successful reperfusion and the relationship between angiographic indices and clinical outcomes in a subset of the APEX-AMI trial, which tested the efficacy of pexelizumab in ST-elevation myocardial infarction patients undergoing primary percutaneous coronary intervention (PCI). METHODS AND RESULTS: Among 5745 patients enrolled in the trial, 1018 underwent independent quantitative angiographic evaluation by a core laboratory. Successful epicardial reperfusion was defined as TIMI (thrombolysis in myocardial infarction) flow grade 3 or corrected TIMI frame count (cTFC) <28 frames, and successful myocardial reperfusion as TIMI myocardial perfusion grade (TMPG) 2 or 3. TIMI 3 flow after PCI occurred in 85%, cTFC < 28 in 58% (mean cTFC was 27 +/- 20), and TMPG 2 or 3 in 91%. Overall 90 day clinical outcomes were 2.7% for mortality and 8.2% for the composite of death, congestive heart failure (CHF), or shock. After adjustment for baseline characteristics, TMPG 2/3 after PCI was associated with younger age [odds ratio (OR) for 10 year increase 0.75, 95% confidence interval (CI) 0.59-0.96, P = 0.023], pre-PCI TIMI flow 2/3 (OR 3.5, 95% CI 1.7-7.1, P = 0.001), and ischaemic time [for every hour, OR 0.81 (0.69-0.96), P = 0.015]. TMPG 2/3 after PCI was significantly associated with 90 day mortality (adjusted hazard ratio 0.26, 95% CI 0.09-0.78, P = 0.013). Neither post-PCI TMPG nor TIMI flow grade was significantly associated with 90 day death/CHF/shock. CONCLUSION: Younger age, patent infarct-related artery at presentation, and ischaemic time predicted higher likelihood of successful myocardial perfusion, which was associated with improved survival.

Duke Scholars

Published In

Eur Heart J

DOI

ISSN

0195-668X

Publication Date

May 2008

Volume

29

Issue

9

Start / End Page

1127 / 1135

Location

England

Related Subject Headings

  • Treatment Outcome
  • Survival Analysis
  • Single-Chain Antibodies
  • Predictive Value of Tests
  • Myocardial Reperfusion
  • Myocardial Infarction
  • Middle Aged
  • Male
  • Humans
  • Female
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Brener, S. J., Moliterno, D. J., Aylward, P. E., van’t Hof, A. W. J., Ruźyllo, W., O’Neill, W. W., … APEX-AMI Investigators, . (2008). Reperfusion after primary angioplasty for ST-elevation myocardial infarction: predictors of success and relationship to clinical outcomes in the APEX-AMI angiographic study. Eur Heart J, 29(9), 1127–1135. https://doi.org/10.1093/eurheartj/ehn125
Brener, Sorin J., David J. Moliterno, Philip E. Aylward, Arnoud W. J. van’t Hof, Witold Ruźyllo, William W. O’Neill, Christian W. Hamm, et al. “Reperfusion after primary angioplasty for ST-elevation myocardial infarction: predictors of success and relationship to clinical outcomes in the APEX-AMI angiographic study.Eur Heart J 29, no. 9 (May 2008): 1127–35. https://doi.org/10.1093/eurheartj/ehn125.
Brener SJ, Moliterno DJ, Aylward PE, van’t Hof AWJ, Ruźyllo W, O’Neill WW, et al. Reperfusion after primary angioplasty for ST-elevation myocardial infarction: predictors of success and relationship to clinical outcomes in the APEX-AMI angiographic study. Eur Heart J. 2008 May;29(9):1127–35.
Brener, Sorin J., et al. “Reperfusion after primary angioplasty for ST-elevation myocardial infarction: predictors of success and relationship to clinical outcomes in the APEX-AMI angiographic study.Eur Heart J, vol. 29, no. 9, May 2008, pp. 1127–35. Pubmed, doi:10.1093/eurheartj/ehn125.
Brener SJ, Moliterno DJ, Aylward PE, van’t Hof AWJ, Ruźyllo W, O’Neill WW, Hamm CW, Westerhout CM, Granger CB, Armstrong PW, APEX-AMI Investigators. Reperfusion after primary angioplasty for ST-elevation myocardial infarction: predictors of success and relationship to clinical outcomes in the APEX-AMI angiographic study. Eur Heart J. 2008 May;29(9):1127–1135.
Journal cover image

Published In

Eur Heart J

DOI

ISSN

0195-668X

Publication Date

May 2008

Volume

29

Issue

9

Start / End Page

1127 / 1135

Location

England

Related Subject Headings

  • Treatment Outcome
  • Survival Analysis
  • Single-Chain Antibodies
  • Predictive Value of Tests
  • Myocardial Reperfusion
  • Myocardial Infarction
  • Middle Aged
  • Male
  • Humans
  • Female