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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.

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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