Suboptimal Reperfusion in Patients with ST-Segment Elevation Acute Myocardial Infarction Treated with Primary Percutaneous Coronary Intervention: Predictors and Prognostic Value

pp. 257-262

Abstract

Background: Although there is evidence that suboptimal reperfusion has short-term prognostic impact in patients with ST-segment elevation acute coronary syndromes, there is little information about its associated factors.

Objectives: The aim of this study was to analyze the factors associated with suboptimal reperfusion in patients with acute STsegment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI).

Methods: Patients from the SCAR (Acute Coronary Syndromes in Argentina) registry diagnosed with acute STEMI undergoing PCI were included in the study. The association of classical clinical and laboratory variables and the leuko-glycemic index with suboptimal reperfusion was analyzed. Suboptimal reperfusion was defined as TIMI III post-PCI angiography with less than 50% ST-segment decrease in the ECG.

Results: Overall, 197 patients (76.4%) out of 258 patients with STEMI met the inclusion criteria. Among them, 8.6% (n: 17) had suboptimal reperfusion, with an incidence of in-hospital death of 17.6% (n: 3) versus 1.7% (n: 3) in patients without suboptimal reperfusion (p=0.007). In the univariate analysis, variables associated with suboptimal reperfusion were diabetes [OR: 3.2 (1.09-9.43) p=0.026], previous revascularization [OR: 5.8 (1.74-19.07) p=0.008], leuko-glycemic index (>2159) [OR 3.7 (1.32-10.22) p=0.009], and pain-to-balloon time (>159 minutes) [OR: 6.9 (0.88- 53) p=0.045]. Age >70 years, male sex, high blood pressure, smoking, previous or anterior-wall infarction, and Killip and Kimball 3-4 and TIMI 0-1 flow on admission were not significantly different between patients with or without suboptimal reperfusion. Prior to the analysis, the cutoff point for the leuko-glycemic index associated with suboptimal reperfusion was established at 2159 points by ROC curve analysis (NPV: 94%), and the pain-to-balloon time at 159 min (NPV: 96%). In logistic regression analysis, only previous revascularization [OR: 5.3 (1.53-18.55)] and leuko-glycemic index [OR: 3.2 (1.11-9.28)] were associated with suboptimal reperfusion.

Conclusions: Suboptimal reperfusion was significantly associated with a higher incidence of in-hospital death, while previous revascularization and LGI (>2159) were independent factors associated with suboptimal reperfusion.