Document Detail


Beneficial effect of reperfusion therapy beyond the preservation of left ventricular function in patients with acute ST-segment elevation myocardial infarction.
MedLine Citation:
PMID:  19604587     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
BACKGROUND: Reperfusion therapy has been shown to improve mortality in patients with acute ST-segment elevation myocardial infarction. However, in randomized clinical trials there was only a modest improvement in left ventricular ejection fraction with reperfusion therapy, despite a larger improvement in mortality.
METHODS: In the prospective MITRA-Plus registry we compared 1-year mortality of inhospital survivors of ST-segment elevation myocardial infarction (STEMI) divided into nine groups with preserved (>55%), moderately reduced (41-55%) and severely reduced (≤40%) left ventricular ejection fraction (LVEF) and treated with no early reperfusion therapy, fibrinolysis or primary percutaneous coronary intervention (PCI) within 24h after admission.
RESULTS: A total of 5867 patients were included in this analysis, 1026 (18%) without early reperfusion, 2462 (42%) with fibrinolysis and 2379 (40%) with primary PCI. After adjustment for confounding variables in a propensity score analysis, reperfusion therapy (Odds ratio and 95% CI: 0.27, 0.15-0.48; 0.50, 0.32-0.79; 0.64, 0.44-0.93), fibrinolysis (Odds ratio and 95% CI: 0.27, 0.14-0.52; 0.58, 0.35-0.95; 0.60, 0.39-0.93) and primary PCI (Odds ratio and 95% CI: 0.22, 0.11-0.44; 0.34, 0.19-0.59; 0.56, 0.36-0.88) remained independent predictors of survival in comparison to no reperfusion therapy in the patients with preserved, moderately reduced and severely reduced LVEF, respectively.
CONCLUSIONS: These results suggest a beneficial effect of early reperfusion therapy beyond the preservation of left ventricular function, however the mechanisms need further study.
Authors:
Uwe Zeymer; Timm Bauer; Bernard J Gersh; Ralf Zahn; Anselm Gitt; Claus Jünger; Jochen Senges
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Publication Detail:
Type:  Journal Article     Date:  2009-07-14
Journal Detail:
Title:  International journal of cardiology     Volume:  146     ISSN:  1874-1754     ISO Abbreviation:  Int. J. Cardiol.     Publication Date:  2011 Jan 
Date Detail:
Created Date:  2011-01-17     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8200291     Medline TA:  Int J Cardiol     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  177-80     Citation Subset:  IM    
Copyright Information:
Copyright © 2009 Elsevier Ireland Ltd. All rights reserved.
Affiliation:
Herzzentrum Ludwigshafen, Medizinische Klink B, Ludwigshafen, Germany; Institut für Herzinfarktforschung Ludwigshafen an der Universität Heidelberg, Ludwigshafen, Germany.
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