TY - JOUR
T1 - Clinical reinfarction according to infarct location and reperfusion modality in patients with ST elevation myocardial infarction
T2 - For the DANAMI-2 investigators
AU - Busk, Martin
AU - Kristensen, Steen D.
AU - Rasmussen, Klaus
AU - Kelbaek, Henning
AU - Thayssen, Per
AU - Madsen, Jan K.
AU - Abildgaard, Ulrik
AU - Krusell, Lars R.
AU - Mortensen, Leif S.
AU - Thuesen, Leif
AU - Andersen, Henning R.
AU - Nielsen, Torsten T.
PY - 2009/3/1
Y1 - 2009/3/1
N2 - Objectives: To evaluate clinical reinfarction during a 3-year follow-up after randomization to primary angioplasty versus fibrinolysis in anterior and non-anterior ST elevation myocardial infarction (STEMI). Methods: Clinical reinfarction was prospectively assessed by an endpoint committee blinded to the study treatment. Results: At 30 days, primary angioplasty compared with fibrinolysis reduced the reinfarction rate both in anterior STEMI patients (n = 823; 2.5 vs. 5.6%, p = 0.02) and in non-anterior STEMI patients (n = 743; 0.8 vs. 7.4%, p < 0.001). After 3 years, the reduction in reinfarction rate was no longer present in anterior STEMI patients (11.2 vs. 11.2%, p = 0.86), but persisted in non-anterior STEMI patients (5.2 vs. 13.5%, p < 0.001). Reinfarction after anterior STEMI carried a higher mortality than reinfarction after non-anterior STEMI (37.6 vs. 15.3%, p = 0.01). Independent predictors of death were: age [hazard ratio (HR) per 1-year increase in age = 1.08 (1.07-1.09)], clinical reinfarction [HR = 5.15 (3.57-7.43)], anterior index STEMI [HR = 1.65 (1.24-2.19)], and Killip class ≥2 [HR = 1.42 (1.01-2.00)]. The additional late reinfarctions after angioplasty for anterior STEMI were located within the angioplasty-treated target segment. Anterior STEMI patients had smaller mean target vessel diameter, which was associated with reinfarction. Conclusions: Clinical reinfarction is an independent predictor of death. The early superiority of primary angioplasty over fibrinolysis on reinfarction rate after anterior STEMI diminished during long-term follow-up.
AB - Objectives: To evaluate clinical reinfarction during a 3-year follow-up after randomization to primary angioplasty versus fibrinolysis in anterior and non-anterior ST elevation myocardial infarction (STEMI). Methods: Clinical reinfarction was prospectively assessed by an endpoint committee blinded to the study treatment. Results: At 30 days, primary angioplasty compared with fibrinolysis reduced the reinfarction rate both in anterior STEMI patients (n = 823; 2.5 vs. 5.6%, p = 0.02) and in non-anterior STEMI patients (n = 743; 0.8 vs. 7.4%, p < 0.001). After 3 years, the reduction in reinfarction rate was no longer present in anterior STEMI patients (11.2 vs. 11.2%, p = 0.86), but persisted in non-anterior STEMI patients (5.2 vs. 13.5%, p < 0.001). Reinfarction after anterior STEMI carried a higher mortality than reinfarction after non-anterior STEMI (37.6 vs. 15.3%, p = 0.01). Independent predictors of death were: age [hazard ratio (HR) per 1-year increase in age = 1.08 (1.07-1.09)], clinical reinfarction [HR = 5.15 (3.57-7.43)], anterior index STEMI [HR = 1.65 (1.24-2.19)], and Killip class ≥2 [HR = 1.42 (1.01-2.00)]. The additional late reinfarctions after angioplasty for anterior STEMI were located within the angioplasty-treated target segment. Anterior STEMI patients had smaller mean target vessel diameter, which was associated with reinfarction. Conclusions: Clinical reinfarction is an independent predictor of death. The early superiority of primary angioplasty over fibrinolysis on reinfarction rate after anterior STEMI diminished during long-term follow-up.
KW - Angioplasty
KW - Myocardial infarction
KW - Reinfarction
KW - Thrombolytic therapy
KW - Time factor
UR - http://www.scopus.com/inward/record.url?scp=55749105518&partnerID=8YFLogxK
U2 - 10.1159/000171069
DO - 10.1159/000171069
M3 - Article
C2 - 19005253
AN - SCOPUS:55749105518
SN - 0008-6312
VL - 113
SP - 72
EP - 80
JO - Cardiology
JF - Cardiology
IS - 1
ER -