Prognostische Bedeutung der epikardialen Reperfusionsstörung bei Patienten mit akutem Myokardinfarkt
Aims: The study was performed to evaluate predictors for mortality after primary coronary intervention in a multivariate setting. Background: Despite early treatment with modern strategies of coronary intervention and aftercare in myocardial infarction, the rate of adverse outcomes is still high and the patients´ risk factor profile is inhomogeneous. Until now, multivariate predictor analyses to evaluate post coronary intervention mortality in a long-term follow-up setting are only available from multicenter studies. Results from a modern collective of patients in a big observational unicenter study, with standardized treatment, documentation and evaluation don’t exist, so far. Methods: In a nonrandomized, prospective clinical trial, we included 2309 patients who underwent emergency PCI in our cardiac catheterization laboratory because of acute myocardial infarction from 2000 to 2006. From a big range of collected data, 24 potential predictors were predefined. A follow-up was executed with a maximum follow-up time of 3195 days and a median follow-up time of 1456,5 days for the total number of patients. All-cause mortality was the primary endpoint. After a univariate Cox Proportional Hazards Regression Analysis and a Kaplan Meier Survival Analysis for each potential predictor, a multivariate best-subset proportional-hazards regression analysis was performed with all significant univariate predictors. Results: In the univariate Cox Proportional Hazards Regression Analysis twelve of the 24 predefined predictors were significant for the primary end point. The best-subset proportional-hazards regression analysis revealed seven multivariate significant predictors: Patients with Killip-Classification II – IV had a 2,133 times higher risk than patients with Killip-Classification I (95 % CI 1,274 – 3,569). Patients with diabetes mellitus had a 1,890 times higher risk than patients without diabetes mellitus (95 % CI 1,145 – 3,121). Patients with CRP at admission > 8,9 mg/l had a 1,860 times higher risk than patients with CRP at admission ≤ 8,9 mg/l (1,146 – 3,016). Patients with maximum CK > 645 U/l had a 0,424 times lower risk than patients with a maximum CK ≤ 645 U/l (95 % CI 0,251 – 0,717). Patients with a BMI > 27,43 kg/m² had a 0,511 times lower risk than patients with a BMI ≤ 27,43 kg/m² (95 % CI 0,307 – 0,850). Patients with an ejection fraction (EF) > 49,2 % had a 0,580 times lower risk than patients with a EF ≤ 49,2 % (95 % CI 0,351 – 0,958). Patients aged older than 69,8 years had a 2,107 times higher risk than patients aged younger than 69,8 years (95 % CI 1,270 – 3,495). Conclusion: The insights of this multivariate predictor analysis may help to better classify patients and to specify high risk collectives. Further they could help to optimize treatment procedures and aftercare in order to protect patients after PCI in myocardial infarction from cardiac death.
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