Published Online
on February 23, 2004

A more recent version of this article appeared on March 2, 2004

This Article Full Text (PDF) All Versions of this Article: 109/8/958    most recent 01.CIR.0000120504.31457.28v1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by De Luca, G. Articles by Suryapranata, H. Search for Related Content PubMed PubMed Citation Articles by De Luca, G. Articles by Suryapranata, H. Related Collections Catheter-based coronary and valvular interventions: other Acute myocardial infarction

Submitted on November 2, 2003
Revised on November 24, 2003
Accepted on January 14, 2004

Impaired Myocardial Perfusion Is a Major Explanation of the Poor Outcome Observed in Patients Undergoing Primary Angioplasty for ST-Segment-Elevation Myocardial Infarction and Signs of Heart Failure

Giuseppe De Luca MD, Arnoud W.J. van’t Hof MD, Menko-Jan de Boer MD, Jan C.A. Hoorntje MD, A.T. Marcel Gosselink MD, Jan-Henk E. Dambrink MD, Jan Paul Ottervanger MD, Felix Zijlstra MD, and Harry Suryapranata MD^*

From the Department of Cardiology, ISALA Klinieken, De Weezenlanden Hospital, Zwolle, The Netherlands.

^* To whom correspondence should be addressed. E-mail: h.suryapranata{at}diagram-zwolle.nl.

Background--The aim of the present study was to investigate the prognostic implication of myocardial perfusion in patients with ST-segment-elevation myocardial infarction (STEMI) and signs of heart failure, treated with primary angioplasty.

Methods and Results--Our population is represented by 1548 consecutive patients undergoing primary angioplasty for STEMI. Congestive heart failure was defined as Killip class >1 at admission. Killip class was linearly associated with myocardial perfusion, enzymatic infarct size, predischarge ejection fraction, and 1-year mortality rate. Myocardial blush was an independent predictor of 1-year mortality (RR [95% CI]=2.92 [1.37 to 6.23], P=0.005) in patients with advanced Killip class at presentation.

Conclusions--Our study shows that patients with heart failure complicating STEMI have impaired myocardial perfusion, which accounts for the poor outcome observed in these patients. Further efforts should be aimed at improving myocardial perfusion, beyond epicardial recanalization, to further improve the outcome of these high-risk patients.

Key words: angioplasty • heart failure • perfusion

This article has been cited by other articles:

				M. Gick, N. Jander, H.-P. Bestehorn, R.-P. Kienzle, M. Ferenc, K. Werner, T. Comberg, K. Peitz, D. Zohlnhofer, V. Bassignana, et al. Randomized Evaluation of the Effects of Filter-Based Distal Protection on Myocardial Perfusion and Infarct Size After Primary Percutaneous Catheter Intervention in Myocardial Infarction With and Without ST-Segment Elevation Circulation, September 6, 2005; 112(10): 1462 - 1469. [Abstract] [Full Text] [PDF]

				V. Bodi, J. Sanchis, A. Losada, M. P. Lopez-Lereu, D. Garcia, M. Pellicer, F. J. Chorro, and A. Llacer Usefulness of quantitative intravenous myocardial contrast echocardiography to analyze microvasculature perfusion in patients with a recent myocardial infarction and an open infarct-related artery: comparison with intracoronary myocardial contrast echocardiography Eur J Echocardiogr, June 1, 2005; 6(3): 164 - 174. [Abstract] [Full Text] [PDF]

				B. R. Chaitman and M. J. Lim No reflow and the quest to achieve optimal perfusion during the acute phase of myocardial infarction J. Am. Coll. Cardiol., July 21, 2004; 44(2): 313 - 315. [Full Text] [PDF]

				C. M. Gibson and A. Schomig Coronary and Myocardial Angiography: Angiographic Assessment of Both Epicardial and Myocardial Perfusion Circulation, June 29, 2004; 109(25): 3096 - 3105. [Full Text] [PDF]