ACUTE MYOCARDIAL INFARCTION
The incidence, predictors, and outcomes of early reinfarction after primary angioplasty for acute myocardial infarction
Steven J. Kernis, MD*,
Kishore J. Harjai, MD, FACC*,
Gregg W. Stone, MD, FACC ,
Lorelei L. Grines, PhD*,
Judith A. Boura, MS*,
Michael W. Yerkey, MD*,
William O’Neill, MD, FACC* and
Cindy L. Grines, MD, FACC*,*
* Cardiology Division, William Beaumont Hospital, Royal Oak, Michigan, USA
Cardiology Division, Lenox Hill Hospital, New York, New York, USA
Manuscript received March 5, 2003;
revised manuscript received May 14, 2003,
accepted May 21, 2003.
* Reprint requests and correspondence: Dr. Cindy L. Grines, Division of Cardiovascular Medicine, William Beaumont Hospital, 3601 West 13 Mile Road, Royal Oak, Michigan 48073-6769, USA.
cgrines{at}beaumont.edu
OBJECTIVES: We sought to identify the incidence, predictors, and clinical consequences of one-month reinfarction (RE-MI) in patients undergoing primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI).
BACKGROUND: One-month reinfarction after AMI significantly increases long-term mortality; however, little is known about the incidence and predictors of RE-MI in patients undergoing primary angioplasty.
METHODS: We analyzed data from 3,646 patients who underwent primary PCI in the Primary Angioplasty in Acute Myocardial Infarction (PAMI) studies. We studied the incidence, correlates, and clinical outcomes of 30-day RE-MI.
RESULTS: Reinfarction within one month of index hospitalization occurred in 77 (2.1%) of patients. In multivariate analysis, admission Killip class >1 (odds ratio [OR] 2.02, 95% confidence interval [CI] 1.09 to 3.76), left ventricular ejection fraction <50% (OR 2.49, 95% CI 1.30 to 4.74), final coronary stenosis >30% (OR 2.57, 95% CI 1.28 to 5.15), and presence of coronary dissection (OR 2.40, 95% CI 1.36 to 4.24) and thrombus (OR 2.36, 95% CI 1.23 to 4.53) on the final angiogram were independent correlates of RE-MI. One-month reinfarction was independently associated with death (OR 7.14, 95% CI 3.28 to 15.5) and ischemic target vessel revascularization (I-TVR) (OR 15.0, 95% CI 8.68 to 26.0) at six months.
CONCLUSIONS: We conclude that, although early RE-MI is uncommon in patients treated by primary PCI, it is a significant independent predictor of death and I-TVR at six months. Admission Killip class >1 and left ventricular systolic dysfunction were associated with higher incidence of RE-MI. Our results suggest that optimal revascularization during primary PCI may decrease RE-MI rates.
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Abbreviations and Acronyms
| | AMI | = acute myocardial infarction | | CK | = creatinine kinase | | I-TVR | = ischemic target vessel revascularization | | LVEF | = left ventricular ejection fraction | | PAMI | = Primary Angioplasty in Acute Myocardial Infarction | | PCI | = percutaneous coronary intervention | | RE-MI | = reinfarction | | TIMI | = Thrombolysis In Myocardial Infarction |
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