Value Of Degree Of Ischemia On Predictors And Outcome Of Patients After Primary Percutaneous Coronary Intervention For Acute ST-segment Elevation Myocardial Infarction

Part oneObjectiveTo investigate the predictive factors and outcome of grade III ischemia in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention(PCI).MethodsPatients with STEMI from the onset of symptoms to admission within 12 h were divided into two groups based on grade II ischemia (gruop A, n=198) or grade Ⅲ ischemia (group B, n=114) in the admission electrocardiogram. Clinical data, TIMI risk score, ST-segment resolution (STR) and hospital motality were recorded in all patients.ResultsPatients with grade III ischemia were older, more TIMI risk score>3 (P=0.019), Killip class>1 (P=0.041), anterior myocardial infarction (P=0.010), lower EF (P=0.001) and less complete STR. Hospital mortality was higher in patients with grade III ischemia compared with patients with grade II ischemia (1.52% and 6.14%,P=0.041). Logistic regression model analysis confirmed that hospital mortality was independently associated with grade III ischemia (OR:3.284,95% CI:1.005 to 10.730, P=0.049).ConclusionGrade III ischemia is associated with criteria (older age.TIMI risk score> 3,Killip class> l,low ejection fraction and anterior myocardial infarction),poor myocardial reperfusion and higher mortality rate in patients with STEMI.Part twoObjectiveTo analyze the ischemia degree of initial electrocardiogram in the patients of acute ST-segment elevation myocardial infarction (STEMI) and investigate its value in the predicting cardiogenic shock (CS) after percutaneous coronary intervention (PCI)MethodsThree hundred and ninety patients with STEMI from the onset of symptoms to admission within 12h were divided into two groups based on grade II ischemia (group A,248 cases) or grade III ischemia (groupB,142 cases) in the initial electrocardiogram. Clincical data, TIMI risk score, ST-segment resolution (STR), CS and cardiovascular events (hospital mortality, ventricular arrhythmias, reinfarction) were recorded in all patients.ResultsThe grender, time from onset to balloon opening, smoking, hypertension, type 2 diabetes, hyperlipidemia, stroke, postoperative TIMI flow 3 grade, coronary artery lesions and lesions in the left main stem between two groups was not statistically significant (P>0.05). In group B, the rate of ST-segment resolution> 50% was obviously lower than that in group A [53.2%(132/248) vs.29.6%(42/142)] (P<0.01). The incidence of CS, in-hospital death, malignant ventricular arrhythmias in group B was higher than that in group A, and the difference was statistically significant (P<0.05). The age, left ventricular ejection fraction, TIMI risk score>3 points, Killip grade> 1 grade, anterior myocardial infarction between two groups were statistically significant (P<0.05 or P<0.01). The indicatiors that were statistically significant in the univariate analysis were included into Logistic regression model and found that age (P=0.008), Killip class>1 (P=0.049), ST segment resolution rate (P=0.008) and grade Ⅲ ischemia (P=0.001) as independent predictors of CS after PCI.ConclusionsGrade Ⅲ ischemia is an independent predictor of cardiogenic shock after PCI in STEMI patients. And it has predictive value for hospital mortality and ventricular arrhythmias.