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Kishore J Harjai

Publications and source records attributed to Kishore J Harjai.

At least 19 recordsLinked to original sources
PubMed2006

Usefulness of routine unfractionated heparin infusion following primary percutaneous coronary intervention for acute myocardial infarction in patients not receiving glycoprotein IIb/IIIa inhibitors.

We evaluated the utility of a routine postprocedure course of unfractionated heparin after primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) in patients not receiving glycoprotein IIb/IIIa inhibitors. In the CADILLAC study, 2,082 patients with AMI who underwent primary PCI were randomized to receive stents versus percutaneous transluminal coronary angioplasty (PTCA), each with or without abciximab. In a subset of 976 patients who did not receive abciximab, we compared outcomes of patients who received postprocedural heparin (n = 758; 78%; median duration 2 days) with those who did not. In 421 patients treated with PTCA, postprocedural heparin use was associated with lower in-hospital major adverse cardiac events (MACEs; 5.3% vs 11.4%, p = 0.069), 1-year MACEs (22% vs 31%, p = 0.08), and decreased in-hospital moderate/severe bleeding (2.3% vs 8.9%, p = 0.01). By multivariate analyses, heparin use correlated with freedom from in-hospital and 1-year MACEs in patients after PTCA. In contrast, in 555 patients who underwent stenting, postprocedural heparin use was associated with increased bleeding and hospitalization costs without a decrease in early or late MACEs. In conclusion, in patients with AMI treated with coronary stenting without glycoprotein IIb/IIIa inhibitors, routine postprocedural heparin was not associated with any significant benefits and may be safely omitted. However, in a subset of patients treated with PTCA, postprocedural heparin use was independently associated with fewer in-hospital and 1-year MACEs.

Abciximab↗
PubMed2006

Prediction of one-year mortality among 30-day survivors after primary percutaneous coronary interventions.

Little information exists on the features that influence risk factors for death at 1 year among 30-day survivors of ST-elevation myocardial infarction (STEMI) that is treated with primary percutaneous coronary intervention (PCI). Accordingly, we examined 3,280 patients with STEMI who were enrolled in Stent-PAMI and CADILLAC trials, were treated with primary PCI, and survived >30 days after STEMI. Death at 1 year occurred in 74 patients (2.3%) who survived >30 days after their index STEMI. Patients who died at 1 year were more likely to be older and women and have lower body weight and greater prevalence of previous stroke. Similarly, the sum of ST elevations, 3-vessel or left anterior coronary disease, and final Thrombolysis In Myocardial Infarction grade <3 flow was higher, whereas left ventricular ejection fraction was lower among patients who died versus those who survived. The multivariate logistic regression model identified age >70 years (odds ratio [OR] 3.3 95% confidence interval [CI] 1.9 to 5.7), weight <80 kg (OR 1.9, 95% CI 1.1 to 3.6), any tachyarrhythmia during index hospitalization (defined as ventricular or supraventricular tachycardia that required treatment) (OR 2.4, 95% CI 1.2 to 4.8), number of diseased coronary arteries (OR 1.5, 95% CI 1.1 to 2.1), and left ventricular ejection fraction (each 10% decrease, OR 1.5, 95% CI 1.2 to 1.8) as factors independently associated with risk of death at 1 year among 30-day survivors. In conclusion, our study provides a method for clinicians to advise patients who are treated with primary PCI and survive the acute phase of STEMI with regard to patients' long-term prognosis, thus enhancing planning and setting up of realistic expectations.

Abciximab↗
PubMed2006

Does proximal location of culprit lesion confer worse prognosis in patients undergoing primary percutaneous coronary intervention for ST elevation myocardial infarction?

ST segment elevation myocardial infarction (STEMI) from proximally located culprit lesion is associated with greater myocardium at jeopardy. In STEMI patients treated with thrombolytics, proximal culprit lesions are known to have worse prognosis. This relation has not been studied in patients undergoing primary percutaneous coronary intervention (PCI). In 3,535 STEMI patients with native coronary artery occlusion pooled from the primary angioplasty in myocardial infarction database, we compared in-hospital and 1-year outcomes between those with proximal (n = 1,606) versus non-proximal (n = 1,929) culprit lesions. Patients with proximal culprits were more likely to die and suffer major adverse cardiovascular events (MACE) during the index hospital stay (3.8% vs 2.2%, P = 0.006; 8.2% vs 5.8%, P = 0.0066, respectively) as well as during 1-year follow-up (6.9% vs 4.5%, P = 0.0013; 22% vs 17%, P = 0.003, respectively) compared to those with non-proximal culprits. After adjustment for baseline differences, proximal culprit was independently predictive of in-hospital death (adjusted odds ratio% 1.58, 95% confidence intervals, CI 1.05-2.40) and MACE (OR 1.41, CI 1.06-1.86), but not 1-year death or MACE. In addition, proximal culprit was independently associated with higher incidence of ventricular arrhythmias and sustained hypotension during the index hospitalization. The univariate impact of proximal culprit lesion on in-hospital death and MACE was comparable to other adverse angiographic characteristics, such as multivessel disease and poor initial thrombolysis in myocardial infarction flow, and greater than that of anterior wall STEMI. In conclusion, proximal location of the culprit lesion is a strong independent predictor of worse in-hospital outcomes in patients with STEMI undergoing primary PCI.

Aged↗
PubMed2005

Comparison of coronary stenting versus conventional balloon angioplasty on five-year mortality in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention.

Little is known about the influence of stenting versus balloon angioplasty on long-term outcomes (particularly mortality) after primary percutaneous coronary intervention (PCI). We evaluated 2,087 patients with ST-elevation myocardial infarction enrolled in various Primary Angioplasty in Myocardial Infarction (PAMI) trials in the United States, who underwent primary PCI. The main outcome was all-cause mortality at 5 years, obtained through the National Death Index. Of the 2,087 patients, stenting was performed in 692 (33%). The absolute difference in the hospital (2.2% vs 3.3%), 1-year (3.3% vs 5.2%), and 5-year (10% vs 13%) mortality rates favored patients receiving a stent versus conventional balloon therapy, with the difference increasing with time. A multivariate Cox model identified stent use (vs balloon alone) as an independent correlate of lower 5-year mortality (hazard ratio 0.60, 95% confidence interval 0.42 to 0.85). The absolute reduction in mortality was greatest in the highest risk group. In conclusion, compared with balloon angioplasty, stenting during primary PCI not only resulted in better angiographic and short-term outcomes, but also in a sustained beneficial effect on mortality at 5 years. These data support the routine use of coronary stenting in most patients undergoing primary PCI, when feasible.

Angioplasty, Balloon↗
PubMed2005

Left ventricular remodeling and systolic deterioration in acute myocardial infarction: findings from the Stent-PAMI Study.

BACKGROUND: Left ventricular systolic deterioration (LVSD) develops in some patients despite successful percutaneous intervention and medical therapy for myocardial infarction (MI). We sought to determine predictors of LVSD by comparing demographic, procedural, angiographic variables, and 6-month major adverse cardiac events (MACE) in patients with and without LVSD after MI. METHODS: We performed a posthoc analysis of patients prospectively enrolled in the Stent-PAMI trial if they had successful percutaneous intervention for MI (<50% residual stenosis and TIMI-3 grade flow), normal left ventricular systolic function on index ventriculogram, and protocol driven coronary angiography with ventriculography at 6 months. We defined LVSD as an absolute decrease in ejection fraction > or =15% compared to baseline value. RESULTS: Of the 900 patients enrolled in Stent-PAMI, 187 patients met the inclusion criteria. LVSD developed in 30 patients (16%) and occurred independent of demographic, procedural, angiographic variables, and 6-month MACE. Multivariate predictors of LVSD were higher baseline ejection fraction (P = 0.0065, OR 1.09; 95% CI = 1.02-1.16) and peak creatine phosphokinase (CPK) level (P = 0.0022, OR 1.04; 95% CI = 1.02-1.07). CONCLUSIONS: LVSD occurs in a minority of patients despite successful mechanical reperfusion and occurred independent of procedural, angiographic variables, target vessel revascularization, reinfarction, and combined MACE. Infarct size (determined by peak CPK) and high baseline ejection fraction predicted development of LVSD at 6 months. LVSD in this population likely occurred by negative left ventricular remodeling.

Creatine Kinase↗
PubMed2005

Ischemia-driven target vessel revascularization after-primary percutaneous coronary intervention: patients at risk and their outcomes.

Clinical and angiographic correlates of ischemia-driven target vessel revascularization (ITVR) in patients undergoing primary percutaneous coronary interventions (PCI) are currently less well known. Accordingly, we examined 2,981 patients enrolled in different Primary Angioplasty in Myocardial Infarction trials, who underwent primary PCI to evaluate risk factors and outcomes of individuals requiring subsequent ITVR. At 6 months, ITVR was required in 321 patients (11%). Compared to the cohort without ITVR, patients requiring ITVR were younger (P=0.036), females (P=0.018), and more likely to have systolic blood pressure >100 mmHg on presentation (P=0.022), family history of premature coronary artery disease (P=0.035), and postprocedure dissection (P=0.001). In contrast, Killip Class >I on presentation (P=0.05), left circumflex as infarct-related artery (P=0.022), and the use of ticlopidine (P=0.044) and stents (p=0.057) were less frequent among ITVR patients. Multivariate analysis identified younger age (for each 10-year decrease, odds ratio [OR], 1.18; 95% confidence interval [CI], 1.06-1.32), female gender (OR: 1.41, 95% CI: 1.05-1.89), and final dissection (OR: 1.69, 95% CI: 1.23-2.33) as independent risk factors for ITVR. In-hospital reinfarction (P < 0.001) was increased and at 6 months remained higher in ITVR patients; in-hospital and 6-month mortality did not differ between the two groups. Our study identifies the incidence, risk factors, and outcomes of patients requiring ITVR after primary PCI. Importantly, our data suggest that no increase in mortality occur, if ITVR is promptly performed to treat recurrent ischemia after primary PCI.

Angioplasty, Balloon, Coronary↗
PubMed2004

Procedural success versus clinical risk status in determining discharge of patients after primary angioplasty for acute myocardial infarction.

OBJECTIVES: We evaluated whether patients' clinical status, angioplasty success, or both, should guide discharge after primary angioplasty (i.e., percutaneous coronary intervention [PCI]) for acute myocardial infarction (AMI). BACKGROUND: Current guidelines do not address a discharge strategy for AMI patients undergoing successful PCI. METHODS: Patients who underwent PCI in Primary Angioplasty in Myocardial Infarction (PAMI) studies (N = 3,188) were classified as "high clinical risk" if they had either age >70 years, Killip class >1, heart rate >100 beats/min, systolic blood pressure <100 mm Hg, anterior MI, or left bundle branch block, and as "low clinical risk" if none was present. Successful PCI patients were compared with those with unsuccessful PCI in both groups for 30-day major adverse cardiac events (MACE). RESULTS: Percutaneous coronary intervention was successful in 668 (90%) of 745 low-risk clinical and 2,104 (86%) of 2,443 high-risk clinical patients. Regardless of clinical risk status, patients with successful PCI had lower 30-day MACE than those with unsuccessful PCI (low-risk group: 4.6% vs. 22%, p < 0.0001; high-risk group: 7% vs. 21%; p < 0.0001). Moreover, successful PCI patients with either risk status had few MACE after day 4, whereas unsuccessful PCI patients had more MACE. The success of PCI was the strongest independent predictor of 30-day MACE (odds ratio [OR] 3.7, 95% confidence interval [CI] 2.8 to 5.0). A constellation of three or more high-risk clinical features also predicted higher 30-day MACE (OR 2.25, 95% CI 1.62 to 3.12). CONCLUSIONS: The success of PCI is the prime determinant of clinical outcome after PCI for AMI. The majority of AMI patients with less than three high-risk clinical features who undergo successful PCI may be discharged from the hospital by day 4. In contrast, patients with more than two high-risk clinical features or unsuccessful PCI may need longer observation.

Aged↗
PubMed2004

Impact of interventionalist volume, experience, and board certification on coronary angioplasty outcomes in the era of stenting.

It has been suggested that percutaneous coronary intervention (PCI) by high-volume operators may be associated with better outcomes. However, the relation between operator and outcome is confounded by hospital caseloads of PCI, with busier hospitals generally having better outcomes. We assessed the effect of operator characteristics (volume of PCI, years in practice, and board certification status) on contemporary outcomes of PCI in a busy center with high-volume operators. Between 1999 and 2001, 12,293 PCIs were performed at our center by 28 interventionalists. Patients' clinical risk was assessed with the previously validated Beaumont PCI Risk Score. Operators were classified as producing low, medium, or high volume (tertiles of annual PCI volume < or =92, 93 to 140, or >140, respectively), as less, medium, or great experience (tertiles of years in practice < or =8, 9 to 14, or >14 years, respectively), and board certified (68%) or not. In-hospital death rate and a composite end point (death, coronary artery bypass graft surgery, myocardial infarction, or stroke) occurred in 0.99% and 2.59% of patients, respectively. Operator volume, experience, and board certification showed no univariate or multivariate relation with the study end points. The Beaumont PCI Risk Score showed a strong independent relation with in-hospital death rate (adjusted odds ratio 1.37, 95% confidence interval 1.31 to 1.43, p <0.0001) and composite end point (odds ratio 1.19, 95% confidence interval 1.16 to 1.22, p <0.0001). We conclude that, in contemporary PCI practice at a large center with high-volume operators, in-hospital outcomes are not affected by operator volume, experience, or board certification. Rather, patients' clinical risk score is the overriding determinant of clinical outcomes. Our findings emphasize the power of a well-organized high-volume system to minimize the impact of operator factors on outcomes of PCI.

Aged↗
PubMed2004

Impact of nephropathy after percutaneous coronary intervention and a method for risk stratification.

Radiocontrast-induced nephropathy (RCIN) after percutaneous coronary intervention (PCI) is associated with grave consequences, but risk stratification of patients has not been well elucidated. This analysis derived a time-insensitive score to predict the risk of RCIN after PCI. A derivation cohort (1993 to 1998) and a validation cohort (1999 to 2002) comprised 20,479 patients who underwent PCI. RCIN after PCI was defined as a >/=1.0 mg/dl increase in serum creatinine. Variables having an independent correlation for RCIN after PCI were used to derive the RCIN risk score from the derivation cohort and were tested in the validation cohort. RCIN occurred in 2% of patients after PCI. Independent variables (with weighted scores) include estimated creatinine clearance <60 ml/min (2), urgent PCI (2), intra-aortic balloon pump use (2), diabetes mellitus (1), congestive heart failure (1), hypertension (1), peripheral vascular disease (1), and contrast volume >260 ml (1). The incidence of RCIN after PCI increased with each unit increase in score (p <0.0001, concordance statistic 0.89). No patient with a score </=1 developed nephropathy, whereas 26% of patients with a score >/=9 developed RCIN after PCI (p <0.0001). Propensity score analysis showed that patients who developed RCIN after PCI, irrespective of the need for hemodialysis, had higher in-hospital rates of major adverse cardiac events (odds ratio 15, 95% confidence interval 11 to 20, p <0.0001). RCIN occurred in 2.0% of PCI patients and was associated with a 15-fold increase in adverse cardiac events. The RCIN risk score was a clinical assessment tool with excellent predictive ability in identifying the larger population at risk for nephropathy in whom preventative strategies are indicated.

Aged↗
PubMed2004

Does beta-blocker therapy improve clinical outcomes of acute myocardial infarction after successful primary angioplasty?

OBJECTIVES: We sought to determine if beta-blocker therapy improves clinical outcomes of acute myocardial infarction (AMI) after successful primary percutaneous coronary intervention (PCI). BACKGROUND: We have shown that pre-treatment with beta-blockers has a beneficial effect on short-term clinical outcomes in patients undergoing primary PCI for AMI. It is unknown if beta-blocker therapy after successful primary PCI improves prognosis of AMI. METHODS: We analyzed clinical, angiographic, and outcomes data in 2442 patients who underwent successful primary PCI in the Primary Angioplasty in Acute Myocardial Infarction-2 (PAMI-2), PAMI No Surgery-on-Site (PAMI noSOS), Stent PAMI, and Air PAMI trials. We classified patients into beta group (those who received beta-blockers after successful PCI, n = 1661) and no-beta group (n = 781). We compared death and major adverse cardiac events (MACE) (death, reinfarction, and ischemia-driven target vessel revascularization) at six months between groups receiving and not receiving beta-blockers. RESULTS: At six months, beta patients were less likely to die (2.2% vs. 6.6%, p < 0.0001) or experience MACE (14 vs. 17%, p = 0.036). In multivariate analysis, beta-blockers were independently associated with lower six-month mortality (odds ratio [OR] 0.43, 95% confidence interval [CI] 0.26 to 0.73, p = 0.0016). Beta-blocker therapy was an independent predictor of lower six-month events in high-risk subgroups: ejection fraction <or=50% (death: OR 0.34, 95% CI 0.19 to 0.60, p = 0.0002) or multi-vessel coronary artery disease (CAD) (death: OR 0.26, 95% CI 0.14 to 0.48, p < 0.0001; MACE: OR 0.57, 95% CI 0.41 to 0.80, p = 0.0011). CONCLUSIONS: Treatment with beta-blockers after successful primary PCI is associated with reduced six-month mortality, with the greatest benefit in patients with a low ejection fraction or multi-vessel CAD.

Adrenergic beta-Antagonists↗
PubMed2004

Sustained ventricular tachycardia or fibrillation in the cardiac catheterization laboratory among patients receiving primary percutaneous coronary intervention: incidence, predictors, and outcomes.

OBJECTIVES: We sought to evaluate the incidence, predictors, and outcomes of ventricular tachycardia and/or ventricular fibrillation (VT/VF) in the cardiac catheterization laboratory among patients undergoing primary percutaneous coronary intervention (PCI). BACKGROUND: Although VT/VF has been known to occur during primary PCI, the current data do not identify patients at risk for these arrhythmias or the outcomes of such patients. METHODS: We evaluated 3065 patients enrolled in the Primary Angioplasty in Myocardial Infarction (PAMI) trials, who underwent primary PCI to evaluate the associations of VT/VF and the influence of these arrhythmias on in-hospital and one-year outcomes. RESULTS: In patients undergoing primary PCI, VT/VF occurred in 133 (4.3%). Multivariate analysis identified the following as independent correlates of VT/VF: smoking (odds ratio [OR] 1.95, 95% confidence interval [CI] 1.26 to 3.02), lack of preprocedural beta-blockers (OR 2.34, 95% CI 1.35 to 4.07), time from symptom onset to emergency room of <or=180 min (OR 2.63, 95% CI 1.42 to 4.89), initial Thrombolysis In Myocardial Infarction (TIMI) flow grade 0 (OR 2.06, 95% CI 1.23 to 3.47), and right coronary artery-related infarct (OR 1.93, 95% CI 1.25 to 2.99). Although patients with VT/VF had a higher incidence of bradyarrhythmias, hypotension, cardiopulmonary resuscitation, and endotracheal intubation in the catheterization laboratory, their in-hospital and one-year adverse outcomes were similar to those of the cohort without these arrhythmias. CONCLUSIONS: Our findings suggest that the incidence of VT/VF during primary PCI is low, indicating that these arrhythmias do not influence PCI success or in-hospital or one-year outcomes. Our data further help identify patients at risk of VT/VF during primary PCI and suggest that pretreatment with beta-blockers should be strongly considered to reduce these arrhythmias.

Aged↗
PubMed2004

Characteristics of cerebrovascular accidents after percutaneous coronary interventions.

OBJECTIVES: We sought to identify the incidence, predictors, and clinical implications of cerebrovascular accidents (CVAs) after percutaneous coronary interventions (PCIs). BACKGROUND: Cerebrovascular accidents after PCI, although rare, can be devastating. Limited information exists regarding the characterization of this complication. METHODS: The study population comprised 20,679 patients who underwent PCI between September 1993 and April 2002. A CVA was defined as a composite of transient ischemic attack (TIA) and stroke. The characteristics of those who had a periprocedural CVA were compared with those who did not. RESULTS: A CVA occurred in 92 patients (0.30% of procedures). Of these, TIA occurred in 13 patients (0.04%) and stroke in 79 patients (0.25%). On multivariate analysis, patients with this complication more frequently had diabetes mellitus (adjusted odds ratio [OR] 1.8, 95% confidence interval [CI] 1.1 to 3.0; p = 0.013), hypertension (OR 1.9, 95% CI 1.1 to 3.3; p = 0.033), previous CVA (OR 2.3, 95% CI 1.3 to 4.0; p = 0.0059), and creatinine clearance < or =40 ml/min (OR 3.1, 95% CI 1.8 to 5.2; p < 0.0001). They underwent urgent or emergent procedures (OR 2.7, 95% CI 1.3 to 5.5; p = 0.0092) with more thrombolytic (OR 4.7, 95% CI 2.3 to 9.7; p < 0.0001) and intravenous heparin (OR 1.9, 95% CI 1.1 to 3.4; p = 0.030) use before PCI, and they more often required emergent intra-aortic balloon pump placement (OR 2.2, 95% CI 1.1 to 4.3; p = 0.028). On multivariate analysis, CVA was independently associated with in-hospital death (OR 7.8, 95% CI 4.2 to 14.7; p < 0.0001), acute renal failure (OR 2.8, 95% CI 1.4 to 5.7; p = 0.0042), and new dialysis (OR 3.73, 95% CI 1.01 to 13.8; p = 0.049) after PCI. CONCLUSIONS: Cerebrovascular accidents after PCI, although rare, are associated with high rates of in-hospital death and acute renal failure, often requiring dialysis.

Aged↗
PubMed2004

Stenting of anomalous left carotid artery using a radial artery approach.

A 90-year-old male presented with symptomatic severe stenosis of an anomalous left carotid artery originating from the brachicephalic trunk. A previous attempt at selective cannulation of the left carotid artery was unsuccessful using a transfemoral approach. We performed successful carotid artery angioplasty and stenting using a right radial artery approach.

Aged↗
PubMed2003

Prognostic significance of transient no-reflow during primary percutaneous coronary intervention for ST-elevation acute myocardial infarction.

We found that of 1,192 patients who underwent primary percutaneous coronary intervention and who had final Thrombolysis In Myocardial Infarction grade 3 flow at the conclusion of the procedure, transient no-reflow occurred in 16 patients (1.3%). Compared with patients without transient no-reflow during the procedure, those with transient no-reflow had higher in-hospital (2% vs 13%, p=0.04) and 6-month mortality (3% vs 31%, adjusted odds ratio 5.4, 95% confidence interval 1.01 to 29.0, p=0.0001).

Angioplasty, Balloon↗
PubMed2003

Clinical and angiographic correlates and outcomes of suboptimal coronary flow inpatients with acute myocardial infarction undergoing primary percutaneous coronary intervention.

OBJECTIVES: The purpose of this study was to determine the clinical and angiographic correlates and outcomes of patients with suboptimal coronary flow after primary percutaneous coronary interventions (PCI). BACKGROUND: The clinical and angiographic correlates and outcomes of Thrombolysis in Myocardial Infarction (TIMI) < or =2 flow in patients treated with primary PCI are not known. METHODS: We evaluated 3,362 patients with ST elevation myocardial infarction enrolled in various Primary Angioplasty in Myocardial Infarction trials, who underwent primary PCI. RESULTS: Post-procedural final TIMI < or =2 flow occurred in 232 (6.9%) patients. Multivariate analysis identified age > or =70 years (odds ratio [OR], 1.6; 95% confidence interval [CI], 1.1 to 2.2), diabetes (OR 1.9; 95% CI, 1.3 to 2.7), symptom onset to emergency room presentation (OR 1.1; 95% CI, 1.1 to 1.2); initial TIMI < or =1 flow (OR 3.2; 95% CI, 1.9 to 5.5), and left ventricular ejection fraction <50% (OR 1.7; 95% CI, 1.2 to 2.4) as independent correlates of final TIMI < or =2 flow. In-hospital (composite of reinfarction, ischemic target vessel revascularization, or death, as well as these events individually) and one-year (reinfarction and/or death) events occurred more frequently in patients with TIMI < or =2 flow. The Cox proportional hazards model identified TIMI < or =2 flow to be independently associated with one-year mortality (hazard ratio 3.8, 95% CI, 2.5 to 5.7). CONCLUSIONS: Final TIMI < or =2 flow, although uncommon after primary PCI, was strongly associated with hospital and one-year adverse events. The clustering of final TIMI < or =2 flow in high-risk groups may partially explain the poor prognosis of these patients. Awareness of these risk factors may be useful to clinicians to triage and treat patients undergoing primary PCI.

Aged↗
PubMed2003

Variation in hospital length of stay in patients with acute myocardial infarction undergoing primary angioplasty and the need to change the diagnostic-related group system.

Our findings show significant variation in length of hospital stay among patients with acute myocardial infarction treated with primary percutaneous coronary intervention; length of stay can be predicted from baseline clinical and angiographic characteristics. Our investigation suggests the need for a multi-tier diagnostic-related group system for patients with acute myocardial infarction treated with percutaneous coronary intervention.

Aged↗
PubMed2003

The incidence, predictors, and outcomes of early reinfarction after primary angioplasty for acute myocardial infarction.

OBJECTIVES: We sought to identify the incidence, predictors, and clinical consequences of one-month reinfarction (RE-MI) in patients undergoing primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI). BACKGROUND: One-month reinfarction after AMI significantly increases long-term mortality; however, little is known about the incidence and predictors of RE-MI in patients undergoing primary angioplasty. METHODS: We analyzed data from 3,646 patients who underwent primary PCI in the Primary Angioplasty in Acute Myocardial Infarction (PAMI) studies. We studied the incidence, correlates, and clinical outcomes of 30-day RE-MI. RESULTS: Reinfarction within one month of index hospitalization occurred in 77 (2.1%) of patients. In multivariate analysis, admission Killip class >1 (odds ratio [OR] 2.02, 95% confidence interval [CI] 1.09 to 3.76), left ventricular ejection fraction <50% (OR 2.49, 95% CI 1.30 to 4.74), final coronary stenosis >30% (OR 2.57, 95% CI 1.28 to 5.15), and presence of coronary dissection (OR 2.40, 95% CI 1.36 to 4.24) and thrombus (OR 2.36, 95% CI 1.23 to 4.53) on the final angiogram were independent correlates of RE-MI. One-month reinfarction was independently associated with death (OR 7.14, 95% CI 3.28 to 15.5) and ischemic target vessel revascularization (I-TVR) (OR 15.0, 95% CI 8.68 to 26.0) at six months. CONCLUSIONS: We conclude that, although early RE-MI is uncommon in patients treated by primary PCI, it is a significant independent predictor of death and I-TVR at six months. Admission Killip class >1 and left ventricular systolic dysfunction were associated with higher incidence of RE-MI. Our results suggest that optimal revascularization during primary PCI may decrease RE-MI rates.

Angioplasty, Balloon, Coronary↗