Usefulness of Aspirin Resistance After Percutaneous Coronary Intervention for Acute Myocardial Infarction in Predicting One-Year Major Adverse Coronary Events

The impact of late percutaneous coronary intervention (PCI) in the patients after acute myocardial infarction (AMI) on long term mortality remains to be established. At currently, thrombolysis is accepted as standard therapy when PCI is not immediately available. However, PCI is often performed in stable patients with AMI who are/are not received thrombolysis .We performed the trial that enrolled myocardial infarction patients treated with thrombolysis, late PCI and medically to assess the potential benefits of delayed PCI. We follow up 164 consecutive patients after AMI one year. The patients are divided in two groups; first group-66 patients who received reperfusion (37 patients received only thrombolysis, 10 patients received thrombolysis and PCI 7-9 days after thrombolysis and 19 patients underwent only PCI after 7-9 days) and second group-98 patients medically treated. One year mortality was 3% in the reperfusion group (2/66) and 14,3% in the medical group (14/98) (p=0,016). There were not significant differences between groups about other end points-reinfarctus, coronary artery bypass surgery and PCI performed later after discharge. The major predictors of one year mortality were ages (p<0,001) and ejection fraction (p=0,003). Also, therapy with beta-blockers (p=0,002), statins (p=0,001) and ACE-inhibitors (p=0,024) was associated with better survival. Delayed PCI performed 7-9 days after AMI in the patients who underwent thrombolysis or those did not improves outcome at long-term follow-up

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GRACE, SYNTAX I and SYNTAX II scores as predictors of one-year mace outcome in patients with myocardial infarction treated with percutaneous coronary intervention

Vojnosanitetski pregled ◽

10.2298/vsp200204055d ◽

2021 ◽

pp. 55-55

Author(s):

Aleksandar Davidovic ◽

Dane Cvijanovic ◽

Jelica Davidovic ◽

Snezana Lazic ◽

Bratislav Lazic ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Percutaneous Coronary Intervention ◽

Predictive Power ◽

Coronary Intervention ◽

Cardiovascular Outcomes ◽

Adverse Outcomes ◽

Risk Scores ◽

Percutaneous Coronary ◽

One Year

Background/Aim. The fundamental objective of primary percutaneous coronary intervention (PKI) in myocardial infarction is to provide early, complete and sustained flow in the occluded artery that has led to myocardial ischemia or necrosis. The aim of this study was to determine the predictive power of a combination of GRACE, SYNTAX I, and SYNTAX II scores in predicting major cardiovascular adverse events and one-year mortality in patients with STEMI and NSTEMI myocardial infarction after primary PCI. Methods. Our study included 400 patients who had their first acute myocardial infarction and underwent percutaneous coronary intervention, treated and followed for one year at the Clinical Hospital Center Zvezdara at the Department of Interventional Cardiology. By monitoring the defined clinical parameters, a comparative analysis of risk scores was performed: GRACE, SYNTAX I and SYNTAX II, their sensitivity, specificity as well as predictive possibilities in predicting adverse outcomes were determined. Results. The incidence of major adverse cardiovascular outcomes in our sample was 12,8%. Patients with STEMI entity had significantly higher values of GRACE, SYNTAX I and SYNTAX II scores. The highest value for predicting the occurrence of major adverse cardiovascular outcomes was shown by the SYNTAX II score (score value 29,3) with a sensitivity of 88,2% and a specificity of 76,8%. The GRACE score is a significant predictor of SYNTAX I and SYNTAX II scores, a two-way correlation was observed between the high score values of all three scores. Conclusion. The presented scores for assessment of clinical and angiographic indicators, showed good predictive power in assessing the outcome of adverse cardiovascular events in both clinical entities of acute myocardial infarction during one year follow up. By using the proposed scores to assess adverse outcomes, we can single out high-risk patients in order to prevent outcomes and reduce mortality. This suggests its suitability for clinical use in this patient population.

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