Prediction of enzymatic infarct size in ST-segment elevation myocardial infarction
| Autor: | Peter X. Adams, Thomas G. Todaro, Christopher B. Granger, Yuliya Lokhnygina, Kenneth W. Mahaffey, James S. Mills, Witold Rużyłło, Jose C. Nicolau, Paul W. Armstrong |
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| Rok vydání: | 2012 |
| Předmět: |
Male
medicine.medical_specialty Adverse outcomes Cardiac biomarkers medicine.medical_treatment Myocardial Infarction Antibodies Monoclonal Humanized Coronary Angiography Severity of Illness Index Electrocardiography Internal medicine Angioplasty Myocardial Revascularization medicine Creatine Kinase MB Form Humans ST segment In patient cardiovascular diseases Myocardial infarction Infusions Intravenous Aged Retrospective Studies Dose-Response Relationship Drug biology business.industry Myocardium General Medicine Middle Aged Prognosis medicine.disease Infarct size Treatment Outcome cardiovascular system Cardiology biology.protein Female Creatine kinase Cardiology and Cardiovascular Medicine business Follow-Up Studies Single-Chain Antibodies |
| Zdroj: | Coronary Artery Disease. 23:118-125 |
| ISSN: | 0954-6928 |
| DOI: | 10.1097/mca.0b013e32834e4f8f |
| Popis: | Predictors of adverse outcomes following myocardial infarction (MI) are well established; however, little is known about what predicts enzymatically estimated infarct size in patients with acute ST-elevation MI. The Complement And Reduction of INfarct size after Angioplasty or Lytics trials of pexelizumab used creatine kinase (CK)-MB area under the curve to determine infarct size in patients treated with primary percutaneous coronary intervention (PCI) or fibrinolysis.Prediction of infarct size was carried out by measuring CK-MB area under the curve in patients with ST-segment elevation MI treated with reperfusion therapy from January 2000 to April 2002. Infarct size was calculated in 1622 patients (PCI=817; fibrinolysis=805). Logistic regression was used to examine the relationship between baseline demographics, total ST-segment elevation, index angiographic findings (PCI group), and binary outcome of CK-MB area under the curve greater than 3000 ng/ml.Large infarcts occurred in 63% (515) of the PCI group and 69% (554) of the fibrinolysis group. Independent predictors of large infarcts differed depending on mode of reperfusion. In PCI, male sex, no prior coronary revascularization and diabetes, decreased systolic blood pressure, sum of ST-segment elevation, total (angiographic) occlusion, and nonright coronary artery culprit artery were independent predictors of larger infarcts (C index=0.73). In fibrinolysis, younger age, decreased heart rate, white race, no history of arrhythmia, increased time to fibrinolytic therapy in patients treated up to 2 h after symptom onset, and sum of ST-segment elevation were independently associated with a larger infarct size (C index=0.68).Clinical and patient data can be used to predict larger infarcts on the basis of CK-MB quantification. These models may be helpful in designing future trials and in guiding the use of novel pharmacotherapies aimed at limiting infarct size in clinical practice. |
| Databáze: | OpenAIRE |
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