Impaired Myocardial Perfusion Is a Major Explanation of the Poor Outcome Observed in Patients Undergoing Primary Angioplasty for ST-Segment–Elevation Myocardial Infarction and Signs of Heart Failure

Abstract

Background-The aim of the present study was to investigate the prognostic implication of myocardial perfusion in patients with ST-segment-elevation myocardial infarction (STEMI) and signs of heart failure, treated with primary angioplasty. Methods and Results-Our population is represented by 1548 consecutive patients undergoing primary angioplasty for STEMI. Congestive heart failure was defined as Killip class Ͼ1 at admission. Killip class was linearly associated with myocardial perfusion, enzymatic infarct size, predischarge ejection fraction, and 1-year mortality rate. Myocardial blush was an independent predictor of 1-year mortality (RR [95% CI]ϭ2.92 [1.37 to 6.23], Pϭ0.005) in patients with advanced Killip class at presentation. Conclusions-Our study shows that patients with heart failure complicating STEMI have impaired myocardial perfusion, which accounts for the poor outcome observed in these patients. Further efforts should be aimed at improving myocardial perfusion, beyond epicardial recanalization, to further improve the outcome of these high-risk patients.

Bioresorbable everolimus-eluting vascular scaffold in patients with ST-segment elevation myocardial infarction: Optical coherence tomography evaluation and clinical outcomes

“…It has been hypothesized that due to the higher profile of BVS, its placement in acute thrombotic lesions might require a more intense lesion preparation compared with standard metallic stents, which may increase the risk of distal embolization, no-reflow phenomenon and reduced final TIMI flow [15]. Nevertheless, TIMI 3 flow and MBG rate were high and comparable with those reported in previous studies on pPCI with stents [30][31][32]. Distal embolization occurred only in 1 (4.3%) case and no-reflow phenomenon in none.…”

Impact of multivessel disease on infarct size among STEMI patients undergoing primary angioplasty

“…However, due to the small proportion (4.1%), this issue is not expected to have relevant impact on our results, as confirmed by the analysis after the exclusion of these patients. The absence of a significant association between multivessel disease and cardiogenic shock at admission may be due to a potential selection bias, as much as to the relatively small sample size [37,38]. Finally, we classified our population according to the number of diseased vessels.…”

Coronary and Myocardial Angiography

“…62,63 Impaired myocardial perfusion on the angiogram has in turn been associated with greater left ventricular end-diastolic pressure 64 and the presence of overt congestive heart failure on presentation. 65 Among patients presenting with cardiogenic shock, a restoration of normal myocardial perfusion is associated with improved survival. 66 There are data associating abnormal myocardial perfusion on the angiogram with slower Doppler velocity measurements in the epicardial artery.…”