Predictors of acute heart failure in patients with ST-segment elevation myocardial infarction of the electrocardiogram after PCI

Over the last 50 years, the treatment of acute ST-segment elevation myocardial infarction (STEMI) has been considerably improved. The widespread implementation of reperfusion (initially pharmacological and later mechanical) resulted in a magnificent reduction in the rates of in-hospital mortality from about 25% in the 1970s to 5% in the late 2010s. Mortality in real life, however, is higher than these figures shown in clinical trials. There is compelling evidence showing the association between duration of ischaemia and mortality. This is the basis for the timely reperfusion in STEMI. All actions should be made to reduce all components of the ischaemic time. Despite these advances, STEMI survivors are still at high risk for developing repetitive events, including reinfarctions, heart failure, and sudden death. Evolving therapies beyond timely reperfusion are contributing to further reduce the morbidity associated with STEMI.

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Interaction of ischaemic postconditioning and thrombectomy in patients with ST-elevation myocardial infarction

Heart ◽

10.1136/heartjnl-2019-314952 ◽

2019 ◽

Vol 106 (1) ◽

pp. 24-32 ◽

Cited By ~ 4

Author(s):

Lars Nepper-Christensen ◽

Dan Eik Høfsten ◽

Steffen Helqvist ◽

Jens Flensted Lassen ◽

Hans-Henrik Tilsted ◽

...

Keyword(s):

Myocardial Infarction ◽

Heart Failure ◽

Primary Endpoint ◽

Coronary Intervention ◽

Primary Pci ◽

St Segment Elevation ◽

Segment Elevation Myocardial Infarction ◽

St Segment ◽

Significant Difference ◽

All Cause Mortality

ObjectiveThe Third Danish Study of Optimal Acute Treatment of Patients with ST-segment Elevation Myocardial Infarction – Ischaemic Postconditioning (DANAMI-3-iPOST) did not show improved clinical outcome in patients with ST-segment elevation myocardial infarction (STEMI) treated with ischaemic postconditioning. However, the use of thrombectomy was frequent and thrombectomy may in itself diminish the effect of ischaemic postconditioning. We evaluated the effect of ischaemic postconditioning in patients included in DANAMI-3-iPOST stratified by the use of thrombectomy.MethodsPatients with STEMI were randomised to conventional primary percutaneous coronary intervention (PCI) or ischaemic postconditioning plus primary PCI. The primary endpoint was a combination of all-cause mortality and hospitalisation for heart failure.ResultsFrom March 2011 until February 2014, 1234 patients were included with a median follow-up period of 35 (interquartile range 28 to 42) months. There was a significant interaction between ischaemic postconditioning and thrombectomy on the primary endpoint (p=0.004). In patients not treated with thrombectomy (n=520), the primary endpoint occurred in 33 patients (10%) who underwent ischaemic postconditioning (n=326) and in 35 patients (18%) who underwent conventional treatment (n=194) (adjusted hazard ratio (HR) 0.55 (95%confidence interval (CI) 0.34 to 0.89), p=0.016). In patients treated with thrombectomy (n=714), there was no significant difference between patients treated with ischaemic postconditioning (n=291) and conventional PCI (n=423) on the primary endpoint (adjusted HR 1.18 (95% CI 0.62 to 2.28), p=0.62).ConclusionsIn this post-hoc study of DANAMI-3-iPOST, ischaemic postconditioning, in addition to primary PCI, was associated with reduced risk of all-cause mortality and hospitalisation for heart failure in patients with STEMI not treated with thrombectomy.Trial registration numberNCT01435408.

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