Predictors of in-hospital and 6-month outcome after acute myocardial infarction in the reperfusion era: The primary angioplasty in myocardial infarction (PAMI) trial

Stone, Gregg W.; Grines, Cindy L.; Browne, Kevin F.; Marco, Jean; Rothbaum, Donald A.; O’Keefe, James H.; Hartzler, Geoffrey O.; Overlie, Paul; Donohue, Bryan; Chelliah, Noah; Timmis, Gerald C.; Vlietstra, Ronald E.; Strzelecki, Michelle; Puchrowicz-Ochocki, Sylvia; O’Neill, William W.

doi:10.1016/0735-1097(94)00367-y

Cited by 261 publications

(127 citation statements)

References 49 publications

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“…We found that patients with RI were more often elderly and female, presented later, and were more likely to have a reduced left ventricular ejection fraction, all features that have been associated with increased mortality after primary PCI for AMI. 14,18,19 Patients with RI presented with more diffuse atherosclerosis, as evidenced by more frequent peripheral vascular and cerebrovascular disease and triple-vessel coronary artery disease. Patients with RI were also less likely to be discharged on ␤-blockers, which may have contributed to reduced survival.…”

Section: Discussionmentioning

confidence: 99%

Impact of Renal Insufficiency in Patients Undergoing Primary Angioplasty for Acute Myocardial Infarction

et al. 2003

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Background-The prognostic importance of renal insufficiency (RI) in patients undergoing primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) has not been well characterized. Methods and Results-PCI was performed in 2082 AMI patients without shock presenting within 12 hours of symptom onset in a prospective, multicenter randomized trial. RI was defined as a calculated (Cockroft-Gault) creatinine clearance (CrCl) Յ60 mL/min. RI at baseline was present in 18% of patients. Compared with patients without RI, patients with RI were older and were more likely to be female; to have hypertension, peripheral vascular disease, or cerebrovascular disease; and to present in heart failure. Mortality was markedly increased in patients with versus without baseline RI both at 30 days (7.5% versus 0.8%, PϽ0.0001) and at 1 year (12.7% versus 2.4%, PϽ0.0001). Mortality rates increased incrementally for every 10-mL/min decrease in baseline CrCl. By multivariate analysis, reduced baseline CrCl was a powerful independent predictor of 30-day mortality (hazard ratio, 5.77; PϽ0.0001) and remained associated with reduced survival at 1 year (hazard ratio, 1.98; Pϭ0.08). Hemorrhagic complications and transfusion requirements were also increased more than 2-fold in patients with RI, as were severe restenosis (diameter stenosis Ն70%; 20.6% versus 11.8%, Pϭ0.024) and infarct artery reocclusion (14.7% versus 7.3%, Pϭ0.02). Conclusions-Baseline RI in patients with AMI undergoing primary PCI is associated with a markedly increased risk of mortality, as well as bleeding and restenosis. Novel approaches are needed to improve the otherwise poor prognosis of patients with RI and AMI.

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Section: Discussionmentioning

confidence: 99%

Impact of Renal Insufficiency in Patients Undergoing Primary Angioplasty for Acute Myocardial Infarction

et al. 2003

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“…26 The Global Use of Strategies to Open Occluded Coronary Arteries in Acute Coronary Syndromes (GUSTO IIb) trial demonstrated lower 30-day mortality with PCI as compared with fibrinolysis in patients age ≥70 years. 21 Multiple small randomized trials have shown that PCI offers a mortality benefit over thrombolysis in the elderly and in high risk patients with STEMI.…”

Section: Percutaneous Coronary Interventionmentioning

confidence: 99%

Acute Coronary Syndrome in the Elderly

Shanmugasundaram

Alpert

2009

Clinical Cardiology

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The spectrum of acute coronary syndrome (ACS) including unstable angina, non–ST‐elevation myocardial infarction and ST‐elevation myocardial infarction accounts for increasing numbers of deaths among persons age ≥ 65 years in the US. This is important given demographic changes involving falling birth rates and increasing life expectancy. Elderly patients are likely to benefit the most from treatment of ACS, even though community practice still demonstrates less use of cardial medications as an early‐invasive approach among this population. Copyright © 2009 Wiley Periodicals, Inc.

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“…1,2 Significant improvement in mortality and morbidity may be achieved even when reperfusion occurs up to 6 to 12 hours after acute myocardial infarction (MI). 3 However, protracted ischemia may produce an admixture of necrotic and viable myocardium. Although stunned viable myocardium differs structurally and metabolically from irreversibly injured myocardium, both may display similarly depressed mechanical function at rest early after MI.…”

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Early Contrast-Enhanced MRI Predicts Late Functional Recovery After Reperfused Myocardial Infarction

et al. 1999

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Background-We have observed 3 abnormal patterns on contrast-enhanced MRI early after reperfused myocardial infarction (MI): (1) absence of normal first-pass signal enhancement (HYPO), (2) normal first pass signal followed by hyperenhanced signal on delayed images (HYPER), or (3) both absence of normal first-pass enhancement and delayed hyperenhancement (COMB). This study examines the association between these patterns in the first week after MI and late recovery of myocardial contractile function by use of magnetic resonance myocardial tissue tagging. Methods and Results-Seventeen patients (14 men) with a mean age of 53Ϯ12 years were studied after a reperfused first MI. Contrast-enhanced images were acquired immediately after bolus administration of gadolinium and 7Ϯ2 minutes later. Tagged images were acquired at weeks 1 and 7. Circumferential segment shortening (%S) was measured in regions displaying HYPER, COMB, or HYPO contrast patterns and in remote regions (REMOTE) at weeks 1 and 7. At week 1, %S was depressed in HYPER, COMB, and HYPO (9Ϯ8%, 7Ϯ6%, and 5Ϯ4%, respectively) and were less than REMOTE (18Ϯ6%, PϽ0.003). However, in HYPER, %S improved at week 7 from 9Ϯ8% to 18Ϯ5% (PϽ0.001 versus week 1). In contrast, HYPO did not improve significantly (5Ϯ4% to 6Ϯ3%, PϭNS) and COMB tended to improve 7Ϯ6% to 11Ϯ6% (Pϭ0.06). Conclusions-HYPER

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Predictors of in-hospital and 6-month outcome after acute myocardial infarction in the reperfusion era: The primary angioplasty in myocardial infarction (PAMI) trial

Abstract: In the reperfusion era, the two most powerful determinants of freedom from death, reinfarction and recurrent ischemia after myocardial infarction are young age and treatment by primary angioplasty.

Cited by 261 publications

References 49 publications

Impact of Renal Insufficiency in Patients Undergoing Primary Angioplasty for Acute Myocardial Infarction

Impact of Renal Insufficiency in Patients Undergoing Primary Angioplasty for Acute Myocardial Infarction

Acute Coronary Syndrome in the Elderly

Early Contrast-Enhanced MRI Predicts Late Functional Recovery After Reperfused Myocardial Infarction

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