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Prognostic value of clinical, echocardiographic and angiographic indicators in patients with large anterior ST-segment elevation myocardial infarction as a first acute coronary event

Baldi, Cesarea; Polito, Maria V.b; Citro, Rodolfoa; Farina, Rosarioa; Attisano, Tizianaa; Mirra, Marcob; Chiodini, Paoloc; Di Muro, Michele R.a; Di Maio, Marcod; Vigorito, Francescoa; De Vecchis, Renatoe; Bossone, Eduardoa; Piscione, Federicob; Giudice, Pietroa; Galasso, Gennarob

Journal of Cardiovascular Medicine: December 2017 - Volume 18 - Issue 12 - p 946–953
doi: 10.2459/JCM.0000000000000528
Research articles: Coronary artery disease

Background The risk of death in patients affected by ST-elevation segment myocardial infarction (STEMI) is well known, but more data are required to define the in-hospital mortality in special subsets. We sought to assess the prognostic value of indicators in patients with large anterior STEMI as a first acute coronary event, undergoing percutaneous coronary intervention (PCI) and intra-aortic balloon pump (IABP).

Methods and results We evaluated 48 consecutive large anterior STEMI patients admitted as first acute coronary event, undergoing in acute phase both PCI and IABP. Patient demographics, clinical, noninvasive and invasive findings, together with in-hospital complications, were collected. Moreover, findings obtained after a 24-month follow-up were reported. The primary endpoint was in-hospital mortality, whereas the secondary endpoints were out of hospital mortality, rehospitalization for heart failure or reinfarction, and New York Heart Association (NYHA) class at least 2 at follow-up visit. The univariate analysis showed a significant association with symptom to balloon, left anterior descending coronary artery, myocardial blush grade, and wall motion score index. Results of the multivariable analysis revealed the strongest predictive power for in-hospital mortality of proximal left anterior descending coronary artery (odds ratio: 6.9; 95% confidence interval: 1.1–67.7) and of myocardial blush grade 0–1 (odds ratio: 5.5; 95% confidence interval: 1.0–38.8). In-hospital death occurred in 13 patients (27% of total cases), whereas, at follow-up, the mean of survival was 66.7 ± 7.0%.

Conclusion The patients with large anterior STEMI as a first acute coronary event, undergoing PCI and IABP, had a very high in-hospital mortality, whereas the mortality rate over the follow-up period was lower. The involvement of a large territory at risk and the ineffective treatment in terms of myocardial reperfusion were the main predictors of in-hospital mortality.

aDepartment of Cardiology, A.O.U. ‘San Giovanni di Dio e Ruggi D’Aragona’

bChair of Cardiology, Department of Medicine and Surgery, University of Salerno, Salerno

cMedical Statistics Unit, Second University of Naples

dDepartment of Cardiology, Second University of Naples, Monaldi Hospital

eCardiology Unit, Presidio Sanitario Intermedio ‘Elena d’Aosta’, Naples, Italy

Correspondence to Maria V. Polito, Chair of Cardiology, Department of Medicine and Surgery, University of Salerno, San Giovanni di Dio & Ruggi D’Aragona Academic Hospital, Cardiology Tower, Largo Città d’Ippocrate, 84131 Salerno, Italy Tel: +39 089673182/+39 3272611923; e-mail: mvpolito@hotmail.it

Received 25 January, 2017

Revised 3 April, 2017

Accepted 2 May, 2017

© 2017 Italian Federation of Cardiology. All rights reserved.