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Biomedical subjects

Jan-Henk E Dambrink

Publications and source records attributed to Jan-Henk E Dambrink.

At least 19 recordsLinked to original sources
PubMed2007

One year outcomes after glucose-insulin-potassium in ST elevation myocardial infarction. The Glucose-insulin-potassium study II.

BACKGROUND: There are conflicting data concerning the effect of treatment with glucose-insulin-potassium (GIK) in ST segment elevation myocardial infarction (STEMI). Early studies showed beneficial effects of GIK, however, recent large sample size trials did not confirm this, or suggested only benefits in patients without heart failure. We aimed to evaluate long-term effects of GIK in patients with STEMI without signs of heart failure, all treated with reperfusion therapy. METHODS: From August 2003 to December 2004, 889 STEMI patients without signs of heart failure were randomized to standard care (N=445) or additional GIK infusion (N=444). Glucose-potassium (20% glucose with 80 mmol potassium/l) was infused at 2 ml/kg body weight per hour for 12 h through a peripheral line. Short-acting insulin was started according to admission glucose and adjusted based on hourly measured glucose. Clinical end points were of number of death, reinfarction and revascularization at 1 year. RESULTS: One year follow-up was available in 864 patients (97.2%), 432 in the GIK group and 432 in the control group. Mortality rate was 5.3% in GIK and 3.9% in control patients, p=0.33. Rates of reinfarction and revascularization 4.6% vs. 4.6% and 15.5% and 15.0%, in GIK vs. control patients. CONCLUSION: In patients with STEMI without signs of heart failure treated with reperfusion therapy, GIK therapy offers no clinical benefit at 1 year.

Aged↗
PubMed2006

Prognostic importance of troponin T and creatine kinase after elective angioplasty.

BACKGROUND: The prognostic importance of elevated cardiac enzymes after elective percutaneous coronary intervention has been debated. Therefore, we performed a prospective observational study to evaluate the prognostic value of postprocedural rise of troponin T and creatine kinase. METHODS: Troponin T (cut-off value 0.05 ng/ml) and creatine kinase (cut-off value 180 IU/l with muscle-brain fraction >4%) were measured 12 h after elective percutaneous coronary intervention in 713 consecutive patients without elevated troponin before the procedure. Primary endpoint was the combined incidence of death, myocardial infarction, stroke, repeat angiography or re-admission because of anginal symptoms during the follow-up period. RESULTS: Troponin was elevated after the procedure in 150 patients (21%) and creatine kinase in 66 pts (9%), with a strong association between increased troponin and creatine kinase. After a mean follow-up of 10.9 months, mortality was low (1%) and not associated with increased troponin or creatine kinase. There was, however, a strong relation between postprocedural troponin and re-admission for angina (p=0.001) or myocardial infarction (p=0.001). Furthermore, troponin rise was significantly associated with an increased risk of the primary endpoint (relative risk 1.55 95% confidence interval 1.01-2.38). After multivariate analysis, troponin elevation but not increased creatine kinase was associated with an increased risk of the primary endpoint (relative risk 1.59 95% confidence interval 1.02-2.47 for troponin elevation versus 1.16 95% confidence interval 0.62-2.15 for increased creatine kinase). CONCLUSION: Increase of troponin T after elective percutaneous coronary intervention has stronger prognostic implication when compared to increased creatine kinase.

Angioplasty, Balloon, Coronary↗
PubMed2006

Impact of statin therapy at discharge on 1-year mortality in patients with ST-segment elevation myocardial infarction treated with primary angioplasty.

BACKGROUND: Statin therapy can reduce long-term mortality in several subgroups of patients with coronary artery disease, but the benefits after primary angioplasty for ST-segment elevation myocardial infarction (STEMI) have yet to be established. The aim of the current study was to determine whether statin therapy is associated with a reduction in mortality in patients with STEMI treated with primary angioplasty. METHODS: Our population is represented by a total of 1513 consecutive in-hospital survivors treated with primary angioplasty for STEMI between April 1997 and October 2001. Patients were divided in two groups according to statin therapy (statin group, n=893; control group, n=620) at discharge. Clinical follow-up was performed at 1 year. A propensity score, built on the basis of variables independently associated with statin prescription, was used to investigate the benefits from statin therapy in subgroups of patients that were homogeneous in terms of baseline clinical and angiographic characteristics. RESULTS: At 1-year follow-up statin therapy was associated with a significantly lower mortality (1.2% versus 7.1%, R(2) [95% CI]=0.16 [0.09-0.32], p<0.0001). These benefits were confirmed in all subgroups according to the propensity score, and at multivariate analysis (adjusted R(2) [95% CI]=0.24 [0.12-0.47], p<0.0001). CONCLUSIONS: Statin therapy at discharge was associated with a significant reduction in 1-year mortality after primary angioplasty for STEMI. Therefore, the use of statins is highly recommended in these patients.

Aged↗
PubMed2006

A comparison of dual vs. triple antiplatelet therapy in patients with non-ST-segment elevation acute coronary syndrome: results of the ELISA-2 trial.

AIMS: To compare dual vs. triple antiplatelet pre-treatment in patients with non-ST-elevation acute coronary syndrome (NSTE ACS) who were planned for early catheterization. METHODS AND RESULTS: A total of 328 consecutive patients with NSTE ACS were included and were randomized to pre-treatment with dual (n = 166, aspirin, clopidogrel 600 mg) or triple antiplatelet therapy (n = 162, aspirin, clopidogrel 300 mg, and Tirofiban). The primary endpoint was enzymatic infarct size, defined as cumulative LDH release (LDHQ(48)). Initial TIMI flow of the culprit vessel was a pre-specified secondary endpoint. Angiography was performed in 98% of patients at a median of 23 h after admission. Enzymatic infarct size (median, 25-75%) was 166 (60-349) IU/L in the triple group compared with 193 (75-466) IU/L in the dual group (P = 0.2). Initial TIMI 3 flow of the culprit vessel was significantly more often observed after triple antiplatelet therapy (67 vs. 47%, P = 0.002). At 30 days follow-up, myocardial infarction (MI) occurred in 46% of patients in the triple antiplatelet group, compared with 57% in the dual antiplatelet group, P = 0.052. No significant difference in bleeding was present. CONCLUSION: This study showed that in patients with NSTE ACS, triple antiplatelet pre-treatment was associated with a non-significant reduction in enzymatic infarct size, a significantly better initial perfusion of the culprit vessel, and a trend towards a better survival without death or MI. Further, large-scale studies should be performed to find whether the beneficial trend in favour of triple antiplatelet pre-treatment can be reproduced.

Aged↗
PubMed2006

Effect of coronary occlusion site on angiographic and clinical outcome in acute myocardial infarction patients treated with early coronary intervention.

In acute myocardial infarction that is treated with thrombolysis, proximal coronary artery occlusion is associated with worse prognosis, irrespective of the infarcted artery. Primary percutaneous coronary intervention (PCI) is currently the treatment of choice for ST-segment elevation acute myocardial infarction. Therefore, we evaluated the prognostic significance of proximal versus distal coronary artery occlusion in patients with acute myocardial infarction that was treated with primary PCI. Between 1994 and 2001, patients with a first acute myocardial infarction that was treated with primary PCI were analyzed. A lesion was considered proximal if it was located proximal to the first diagonal branch in the left anterior descending coronary artery (LAD), the first marginal obtuse branch in the left circumflex coronary artery, and the first right acute marginal branch in the right coronary artery. Lesions distal of these side branches were considered distal. In total, 1,468 patients were analyzed. Left ventricular ejection fraction (LVEF) for proximal LAD lesions was lower than that for distal ones (37 +/- 11% vs 42 +/- 11%, p <0.0001). Adjusted relative risk of 3-year mortality for proximal versus distal LAD was 4.04 (95% confidence interval 1.95 to 8.38). In patients with infarcts related to the right or left circumflex coronary artery, no significant association between lesion location and LVEF or mortality was seen. No difference was seen in adjusted 3-year mortality between distal LAD and non-LAD-related infarcts (p = 0.145). In conclusion, our analysis shows that, even in patients with acute myocardial infarction that is treated with primary PCI, infarcts related to the proximal LAD have the worst 3-year survival and lowest residual LVEF compared with distal LAD or non-LAD-related infarcts.

Angioplasty, Balloon, Coronary↗
PubMed2006

Predictors and clinical implications of early reinfarction after primary angioplasty for ST-segment elevation myocardial infarction.

BACKGROUND: Recurrent infarction after fibrinolytic therapy has been shown to be associated with increased mortality. The aim of this study was to analyze predictors and outcome of reinfarction in a consecutive series of patients undergoing primary angioplasty. METHODS: Our population is represented by a total of 1955 patients with ST-segment elevation myocardial infarction treated by primary angioplasty between 1997 to 2002. All clinical, angiographic, and follow-up data were prospectively collected. Early reinfarction was defined when two clinical criteria were satisfied within 30 days after the procedure: (1) recurrent ischemic symptoms for >15 minutes after resolution of symptoms from initial MI; (2) new ST-T-wave changes or new Q waves; (3) reelevation in creatine kinase (CK) or CK-MB to higher levels than normal (or by another 20% if already higher than normal). RESULTS: Early reinfarction was observed in 75 (3.8%) patients. At multivariate analysis, advanced Killip class (P = .002), poor preprocedural TIMI flow (P = .014), administration of IIb-IIIa inhibitors (P = .02), and diabetes (P = .038) were independent predictors of 30-day reinfarction. A total of 107 (5.6%) patients had died. Early reinfarction was associated with a significantly higher mortality (22.7% vs 4.9%, P < .001), even after adjustment for confounding factors (blood pressure, diabetes, Killip class, preprocedural TIMI flow, coronary stenting, multivessel disease, anterior infarct location, preprocedural stenosis, and administration of IIb-IIIa inhibitors) (HR 3.32, 95% CI 1.88-5.84, P < .0001). CONCLUSIONS: This study showed that, among patients undergoing primary angioplasty for ST-segment elevation myocardial infarction, advanced Killip class at presentation, poor preprocedural TIMI flow, the use of IIb-IIIa inhibitors, and diabetes are independently associated with 30-day reinfarction. Early reinfarction is an independent predictor of 1-year mortality.

Angioplasty↗
PubMed2006

Impact of infarct location on left ventricular ejection fraction after correction for enzymatic infarct size in acute myocardial infarction treated with primary coronary intervention.

BACKGROUND: Left ventricular function and infarct size are strong predictors for prognosis after acute myocardial infarction (MI). Anterior MI is associated with greater reduction of left ventricular ejection fraction (LVEF) and worse prognosis. Our objective was to study whether the impact of infarct size on global LVEF is dependent of infarct location. METHODS: We analyzed 888 patients treated with primary percutaneous coronary intervention for acute MI. Enzymatic infarct size and LVEF within 1 week were measured. In 490 patients (55%), LVEF was measured a second time at 6 months. RESULTS: Every 1000 U/L of cumulative lactate dehydrogense release corresponded to a decrease of 4.7% (95% CI 4.1-5.3) in LVEF measured within 1 week post MI for left anterior descending coronary artery (LAD)-related infarcts and to a decrease of 2.4% (95% CI 1.7-3.1) in LVEF measured within 1 week post MI for non-LAD-related infarcts (P < .0001). Left ventricular ejection fraction measured 6 months post MI showed a decrease for every 1000 U/L cumulative lactate dehydrogense release of 4.8% (95% CI 4.2-5.3) for LAD and 2.4% (95% CI 1.7-3.1) for non-LAD-related infarcts (P < .0001). Multivariate correction for relevant clinical and angiographic data did not change these results. CONCLUSION: In patients with a first acute MI treated with primary percutaneous coronary intervention, LAD-related infarcts show for a similar amount of myocardial necrosis as determined by enzymatic infarct size, a lower residual LVEF when compared with non-LAD-related infarcts.

Angioplasty, Balloon, Coronary↗
PubMed2006

Feasibility and benefit of prehospital diagnosis, triage, and therapy by paramedics only in patients who are candidates for primary angioplasty for acute myocardial infarction.

BACKGROUND: Despite data showing that time to treatment is very important in ST-elevation myocardial infarct patients, unacceptable long delays to reperfusion remain present in daily life practice. We sought to evaluate the feasibility and effect of improving logistics by early infarct diagnosis in the ambulance and immediate triage to a percutaneous coronary intervention (PCI) center performed by paramedics only without interference of a physician. METHODS: In the On-TIME study, 209 patients were included after prehospital infarct diagnosis and triage in the ambulance (ambulance group, n = 209). Infarct diagnosis was made by highly trained paramedics with the help of a computerized electrocardiographic algorithm. The accuracy of diagnosis, time to treatment, left ventricular function, and clinical outcome were compared with the patients who were diagnosed and triaged at a referral non-PCI center (referred group, n = 258). Left ventricular function was assessed before discharge using a nuclear technique. RESULTS: Acute myocardial infarction was accurately diagnosed in 95% of patients in the ambulance group, as compared with 99% in the referred group (P = .01). The percentage of patients in whom pharmacologic pretreatment (heparin, aspirin, tirofiban, or placebo) was initiated in the ambulance within 90 minutes after the onset of symptoms was 59% in the ambulance group versus 43% in the referred group (P < .01). A left ventricular ejection fraction of <40% was present in 25% in the ambulance group, as compared with 38% in the referred group (P = .013). After multivariate analysis, ambulance triage was independently associated with a left ventricular ejection fraction >40% and a favorable long-term clinical outcome. CONCLUSIONS: Early, prehospital infarct diagnosis, triage, and therapy in the ambulance with direct transportation to the nearest PCI center, performed by trained paramedics only, is feasible in 95% of patients. Ambulance triage resulted in earlier diagnosis and initiation of therapy and was independently associated with a better left ventricular function and clinical outcome, as compared with triage and transportation from a referral non-PCI center.

Angioplasty, Balloon, Coronary↗
PubMed2006

Pre-treatment with clopidogrel and postprocedure troponin elevation after elective percutaneous coronary intervention.

Elevated troponin after elective percutaneous coronary intervention (PCI) has been associated with a worse prognosis. Pretreatment with clopidogrel may be beneficial in patients undergoing PCI. Therefore, a prospective observational study was conducted to address the potential role of clopidogrel in reducing troponin release after elective PCI. TroponinT was measured 12 hours after elective PCI in 656 patients without elevated troponin before PCI. To assess the independent association between pre-treatment with clopidogrel and increased troponin, multivariate analyses were performed. Mean age of the 656 patients was 63.5 years (SD 10.2), 194 patients (30%) were female and 114 patients (17.4%) had diabetes. In 217 patients (33%) troponin was increased after PCI. Of the 330 patients who were not pre-treated with clopidogrel, 118 patients (34%) had increased troponin after the PCI compared to 99 patients (30%) of the 326 patients who were treated with clopidogrel longer than 24 hours before the procedure (p = 0.14). Stratified analyses showed that patients with older age (p = 0.03), previous PCI (p = 0.013), angina CCS 4 (p = 0.03) and multivessel disease (p = 0.04) had a significantly lower risk of troponin increase after pre-treatment with clopidogrel compared to patients without pre-treatment. After adjusting for differences in the other variables, patients who were pre-treated with clopidogrel had a significant lower risk of post-PCI increase of troponin T (odds ratio 0.69, 95% confidence interval 0.49-0.99). Pre-treatment with clopidogrel is associated with a significantly lower incidence of increased troponin after elective PCI. Combined with results of other studies, pre-treatment should be advised in patients waiting for elective PCI.

Aged↗
PubMed2006

Predictors of elevated cardiac troponin T on admission in ST-segment elevation myocardial infarction.

BACKGROUND: In patients with ST-segment elevation acute myocardial infarction (STEMI), elevated cardiac troponin T (cTnT) on admission is associated with poorer outcomes despite early reperfusion. Presentation delay is thought to be the most important factor for the elevation of cTnT on admission. We evaluated presentation delay and other potential predictors of elevated cTnT on admission in patients treated with primary percutaneous coronary interventions (PCI) for STEMI. METHODS: CTnT was measured upon arrival in the PCI centre in 444 patients with acute STEMI. An elevated cTnT was defined as > 0.05 microg/L. RESULTS: The mean age was 61.7 years and patients were admitted at a median of 155 min after symptom onset. Almost 50% had an elevated cTnT on admission. Patients with a positive cTnT on admission were less likely to have successful primary PCI (87 versus 93%, P=0.048) and had significantly higher rates of one-year mortality (4.9 versus 1.3%, P=0.031). There was a significant association between presentation delay and the prevalence of elevated admission cTnT, but even patients with early presentation (<120 min after symptom onset) still had a high prevalence of elevated cTnT (33%). After multivariate analysis, apart from presentation delay, anterior MI location and higher age were independent predictors of elevated cTnT on admission. CONCLUSION: In patients with STEMI, the prevalence of elevated cTnT on admission is high, even in patients with early presentation. Independent predictors of elevated cTnT on admission are presentation delay, increasing age and anterior MI location.

Aged↗
PubMed2005

Ventricular fibrillation in acute myocardial infarction before and during primary PCI.

BACKGROUND: There are scarce and sometimes contradictory data about ventricular fibrillation (VF) during the acute phase of MI. In-hospital VF most often occurs with inferior MI, when treated with fibrinolytics. Out-of-hospital VF seems to be associated with anterior MI. We studied characteristics of patients with VF during reperfusion therapy by primary angioplasty (PCI) versus patients with VF before PCI. METHODS: From January 1995 until December 2001, we treated 2826 patients for acute MI and reviewed clinical records of all patients who developed VF and classified the patients according to the first episode of VF: either before or during the angioplasty procedure. RESULTS: VF developed in 219 (8%) patients. Patients with VF during reperfusion therapy (n=74, 3%) were older (p=0.03), more frequently female (0.04), less often had heart failure (p=0.04), when compared with patient with VF before PCI (n=145, 5%). Patients with VF during PCI experienced more often preinfarction angina (p=0.009) and suffered more often from inferior MI (p=0.001), when compared with patients with VF before PCI. CONCLUSIONS: Patients with early VF before reperfusion have different characteristics when compared with patients with VF during reperfusion. Infarct location is a major determinant of timing of VF, when both groups are compared (p<0.001).

Angioplasty, Balloon, Coronary↗
PubMed2005

Impact of beta-blocker therapy at discharge on long-term mortality after primary angioplasty for ST-segment elevation myocardial infarction.

This study analyzed the effect of beta-blocker therapy at discharge on 1-year mortality rate in a large, unselected cohort of patients who had ST-segment elevation myocardial infarction that was treated by primary angioplasty. Our population is represented by 1,513 patients. At 1-year follow-up, beta blockers at discharge were associated with a significant decrease in mortality rate (2.9% vs 8.5%, RR 0.33, 95% confidence interval [CI] 0.18 to 0.59, p <0.0001), particularly in patients who had anterior wall infarction (3.9% vs 13.4%, RR 0.28, 95% CI 0.14 to 0.54, p <0.0001), whereas nonsignificant benefits were observed in patients who had nonanterior wall infarction (2.0% vs 3.3%, RR 0.6, 95% CI 0.17 to 2.07, p = NS). Benefits in terms of mortality rate that were conferred by beta blockers were confirmed at multivariate analysis that was restricted to patients who had anterior wall infarction (RR 0.43, 95% CI 0.21 to 0.86, p = 0.022).

Adrenergic beta-Antagonists↗
PubMed2005

Absence of seasonal variation in myocardial perfusion, enzymatic infarct size, and mortality in patients with ST-segment elevation myocardial infarction treated with primary angioplasty.

The present study investigated any seasonal variation in myocardial perfusion, enzymatic infarct size, and 1-year mortality in 1,548 patients who underwent primary angioplasty for ST-segment elevation myocardial infarction. No seasonal variation was observed in patients' demographic and clinical characteristics. No difference was observed in the prevalence of heart failure at presentation and in myocardial perfusion, enzymatic infarct size, and 1-year mortality.

Angioplasty, Balloon, Coronary↗
PubMed2005

The impact of glucose-insulin-potassium infusion in acute myocardial infarction on infarct size and left ventricular ejection fraction [ISRCTN56720616].

BACKGROUND: Favorable clinical outcomes have been observed with glucose-insulin-potassium infusion (GIK) in acute myocardial infarction (MI). The mechanisms of this beneficial effect have not been delineated clearly. GIK has metabolic, anti-inflammatory and profibrinolytic effects and it may preserve the ischemic myocardium. We sought to assess the effect of GIK infusion on infarct size and left ventricular function, as part of a randomized controlled trial. METHODS: Patients (n = 940) treated for acute MI by primary percutaneous coronary intervention (PCI) were randomized to GIK infusion or no infusion. Endpoints were the creatinine kinase MB-fraction (CK-MB) and left ventricular ejection fraction (LVEF). CK-MB levels were determined 0, 2, 4, 6, 24, 48, 72 and 96 hours after admission and the LVEF was measured before discharge. RESULTS: There were no differences between the two groups in the time course or magnitude of CK-MB release: the peak CK-MB level was 249 +/- 228 U/L in the GIK group and 240 +/- 200 U/L in the control group (NS). The mean LVEF was 43.7 +/- 11.0 % in the GIK group and 42.4 +/- 11.7% in the control group (P = 0.12). A LVEF < or = 30% was observed in 18% in the controls and in 12% of the GIK group (P = 0.01). CONCLUSION: Treatment with GIK has no effect on myocardial function as determined by LVEF and by the pattern or magnitude of enzyme release. However, left ventricular function was preserved in GIK treated patients.

Aged↗
PubMed2005

Comparison of myocardial perfusion after successful primary percutaneous coronary intervention in patients with ST-elevation myocardial infarction with versus without diabetes mellitus.

Patients with diabetes mellitus (DM) have an adverse prognosis after ST-segment elevation myocardial infarction (STEMI). Whether DM was associated with impaired myocardial reperfusion after successful primary percutaneous coronary intervention for STEMI was investigated. Myocardial reperfusion was assessed by ST-segment resolution and myocardial blush grade (MBG). A total of 386 patients were studied, of whom 64 (17%) had DM. These patients more frequently had reduced MBG (20% vs 10%, p = 0.02) and incomplete ST-segment resolution (55% vs 35%, p = 0.02) compared with patients without DM. After multivariate analysis, DM was still associated with impaired ST resolution (odds ratio 2.1, p = 0.03) and reduced MBG (odds ratio 2.2, p = 0.03).

Angioplasty, Balloon, Coronary↗
PubMed2005

Hyperglycemia is an important predictor of impaired coronary flow before reperfusion therapy in ST-segment elevation myocardial infarction.

OBJECTIVES: This study was designed to investigate whether elevated glucose is associated with impaired Thrombolysis In Myocardial Infarction (TIMI) flow before primary percutaneous coronary intervention (PCI). BACKGROUND: Reperfusion before primary PCI in patients with ST-segment elevation myocardial infarction (STEMI) is associated with an improved outcome. Hyperglycemia in patients with STEMI is associated with an adverse prognosis. Hyperglycemia may induce a pro-thrombotic state and therefore be of influence on TIMI flow before PCI. METHODS: A total of 460 consecutive patients with STEMI treated with primary PCI were included in this analysis. Hyperglycemia was defined as a glucose > or =7.8 mmol/l (140 mg/dl). RESULTS: Hyperglycemia was observed in 70% and TIMI flow grade 3 before primary PCI in 17% of the patients. Patients with hyperglycemia less often had TIMI flow grade 3 before primary PCI (12% vs. 28%, p < 0.001). After adjustment for differences in baseline variables, hyperglycemia was a strong predictor of absence of reperfusion before primary PCI (odds ratio 2.6, 95% confidence interval 1.5 to 4.5). CONCLUSIONS: Hyperglycemia in patients with STEMI is an important predictor of impaired epicardial flow before reperfusion therapy has been initiated. Investigation of methods improving coronary flow before primary PCI in these patients is warranted.

Angioplasty, Balloon, Coronary↗
PubMed2005

Ageing, impaired myocardial perfusion, and mortality in patients with ST-segment elevation myocardial infarction treated by primary angioplasty.

AIMS: It is still unknown whether impaired myocardial perfusion helps to explain the higher mortality observed with ageing in patients with ST-segment elevation myocardial infarction (STEMI) treated with primary angioplasty. METHODS AND RESULTS: In 1548 consecutive patients with STEMI treated with primary angioplasty, myocardial perfusion was evaluated by myocardial blush grade (MBG) and ST-segment resolution. All clinical and follow-up data were prospectively collected. Advanced age was associated with a significantly higher clinical and angiographic risk profile. We found a linear relationship between increasing age, decreased myocardial perfusion, and higher 1-year mortality. After adjustment for baseline potential confounding variables, increased age was still significantly associated with impaired myocardial blush (MBG 0-1) (P=0.028), and ST-segment resolution (<50%) (P=0.007). At multivariable analysis both age (P<0.0001) and poor myocardial perfusion (P<0.0001) were independent predictors of 1-year mortality. CONCLUSION: This study shows that impaired reperfusion is an additional determinant of the poor outcome observed with advanced age in patients with STEMI undergoing mechanical revascularization.

Adult↗