Document Detail


Impact of multivessel coronary artery disease on early ischemic injury, late clinical outcome, and remodeling in patients with acute myocardial infarction treated by primary coronary angioplasty.
MedLine Citation:
PMID:  20071979     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: The mechanism through which multivessel coronary artery disease (MVD) adversely affects the outcome of patients with ST-elevation myocardial infarction (STEMI) is poorly characterized. We assessed whether the impact of MVD on outcome of STEMI patients is because of ischemic damage after primary percutaneous coronary intervention (PPCI) or to late ischemic events. METHODS: From August 2005 to 2007, 288 STEMI patients treated by (bare metal) stent-PPCI were prospectively enrolled. The ischemic injury early after PPCI (evaluated by multiparametric approach) and the incidence of late adverse cardiovascular events were compared between the two groups. RESULTS: Compared with single vessel coronary artery disease, MVD patients (n=134) were older, with higher prevalence of diabetes, prior MI, anterior MI and higher collateral score. Myocardial perfusion as assessed by myocardial blush and SigmaST-segment resolution was similar in the two groups as well as the infarct size and microvascular obstruction as assessed by Troponin I and by the delayed enhancement of cardiac magnetic resonance. At clinical (98% complete) and echocardiogaphic (94% complete) follow-up (median 32 months) MVD patients showed a higher incidence of re-MI (6.1 vs. 1.3%), and urgent revascularization (8.3 vs. 2.7%) and worse left ventricular remodeling than single vessel disease patients. At propensity adjusted analysis MVD was an independent predictor of re-MI (odds ratio: 5.7) and ventricular remodeling (odds ratio: 2.2). CONCLUSION: The impact of MVD on clinical outcome and remodeling of STEMI patients is not because of the extent of ischemic damage observed after PPCI, but to recurrent ischemic events during follow-up.
Authors:
Giuseppe Tarantini; Massimo Napodano; Nicola Gasparetto; Enrico Favaretto; Martina Perazzolo Marra; Luisa Cacciavillani; Claudio Bilato; Elena Osto; Filippo Cademartiri; Giuseppe Musumeci; Francesco Corbetti; Renato Razzolini; Sabino Iliceto
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Coronary artery disease     Volume:  21     ISSN:  1473-5830     ISO Abbreviation:  Coron. Artery Dis.     Publication Date:  2010 Mar 
Date Detail:
Created Date:  2010-02-12     Completed Date:  2010-04-29     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9011445     Medline TA:  Coron Artery Dis     Country:  England    
Other Details:
Languages:  eng     Pagination:  78-86     Citation Subset:  IM    
Affiliation:
Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy. giuseppe.tarantini.1@unipd.it
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MeSH Terms
Descriptor/Qualifier:
Aged
Angioplasty, Transluminal, Percutaneous Coronary* / adverse effects,  instrumentation
Biological Markers / blood
Chi-Square Distribution
Coronary Angiography
Coronary Artery Disease / complications,  diagnosis,  physiopathology,  therapy*
Coronary Circulation
Echocardiography
Female
Humans
Logistic Models
Magnetic Resonance Imaging
Male
Metals
Middle Aged
Myocardial Infarction / diagnosis,  etiology,  physiopathology,  therapy*
Myocardial Perfusion Imaging / methods
Myocardium / pathology*
Odds Ratio
Prospective Studies
Prosthesis Design
Recurrence
Risk Assessment
Risk Factors
Severity of Illness Index
Stents
Time Factors
Treatment Outcome
Troponin I / blood
Ventricular Remodeling*
Chemical
Reg. No./Substance:
0/Biological Markers; 0/Metals; 0/Troponin I

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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