Key result
Microvascular dysfunction after primary angioplasty for acute myocardial infarction independently predicted cardiac death (OR 0.26; 95% CI 0.09-0.72; P=0.010) and combined clinical events.
Why the study?
Does microvascular dysfunction predict left ventricular remodeling and long-term clinical outcomes in patients with acute myocardial infarction after primary angioplasty?
Cohort (n=124)
Does microvascular dysfunction predict left ventricular remodeling and long-term clinical outcomes in patients with acute myocardial infarction after primary angioplasty?
Effect estimate: OR 0.26 (95% CI 0.09 to 0.72)
p-value: p=0.010
Microvascular dysfunction after primary angioplasty for acute myocardial infarction is a strong predictor of adverse left ventricular remodeling and worse long-term clinical outcomes.
Microvascular dysfunction may identify high-risk post-MI patients for closer monitoring; leaves open whether targeted interventions improve outcomes.
BACKGROUND: We hypothesized that preserved microvascular integrity in the area at risk would favorably influence left ventricular (LV) remodeling and long-term outcome after acute myocardial infarction. METHODS AND RESULTS: Before and after successful primary angioplasty (percutaneous transluminal coronary angioplasty [PTCA]), 124 patients with acute myocardial infarction underwent intracoronary myocardial contrast echo (MCE). An MCE score index (MCESI) was derived by averaging the single-segment score (0=not visible, 1=patchy, 2=homogeneous contrast effect) within the area at risk. An MCESI > or =1 was considered adequate reperfusion. Mean follow-up was 46+/-32 months. After PTCA, 100 patients showed adequate reperfusion (no microvascular dysfunction, NoMD), whereas 24 did not (MD). MD patients had a higher mean creatine kinase (4153+/-2422 versus 2743+/-1774 U/L; P=0.002) and baseline wall-motion score index (2.61+/-0.31 versus 2.25+/-0.42; P<0.001) and a lower baseline ejection fraction (33+/-8% versus 40+/-7%; P<0.001). From day 1 on, LV volumes progressively increased in the MD patients (n=19) and were larger than those of NoMD patients (n=85) at 6 months (end-diastolic volume 170+/-55 versus 115+/-29 mL; P<0.001). MCESI was the most important independent predictor of LV dilation (OR 0.61, 95% CI 0.52 to 0.71, P<0.000001). By Cox analysis, MD represented the only predictor of cardiac death (OR 0.26, 95% CI 0.09 to 0.72, P=0.010) and combined events (cardiac death, reinfarction, and heart failure; OR 0.44, 95% CI 0.23 to 0.85, P=0.014). MD patients showed worse survival in terms of cardiac death (P<0.0001) and combined events (P<0.0001). CONCLUSIONS: In reperfused acute myocardial infarction, MD within the risk area is an important predictor of both LV remodeling and unfavorable long-term outcome.
No takes yet. Share an insight, caveat, or question.
Bolognese et al. (2004) conducted a cohort in Acute myocardial infarction (n=124). Microvascular dysfunction (MD) vs. No microvascular dysfunction (NoMD) was evaluated on Cardiac death (OR 0.26, 95% CI 0.09 to 0.72, p=0.010). Microvascular dysfunction after primary angioplasty for acute myocardial infarction independently predicted cardiac death (OR 0.26; 95% CI 0.09-0.72; P=0.010) and combined clinical events.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: