Reverse Left Ventricular Remodelling in ST-Elevation Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Intervention: Incidence, Predictors, and Impact on Outcome - 30/12/17
, Eun Young Yun, PhD a, Jinhee Ahn, MD a, Jin Sup Park, MD a, Hye Won Lee, MD a, Jun-Hyok Oh, MD a, Jeong Su Kim, MD b, Jung Hyun Choi, MD a, Yong Hyun Park, MD b, Han Cheol Lee, MD a, June Hong Kim, MD, PhD b, Kook Jin Chun, MD, PhD b, Taek Jong Hong, MD, PhD a, Youngkeun Ahn, MD, PhD c, Myung Ho Jeong, MD, PhD c, Shung Chull Chae, MD, PhD d, Young Jo Kim, MD, PhD ethe Korea Acute Myocardial Infarction Registry Investigators
Résumé |
Backgroud |
We investigated reverse left ventricular remodelling (r-LVR), defined as a reduction of >10% in left ventricular end-systolic volume (LVESV) during follow-up, in ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PPCI).
Methods |
STEMI patients (n=1,237) undergoing PPCI with echocardiography at baseline and 6-month follow-up were classified into r-LVR (n=466) and no r-LVR groups (n=771). The primary outcome was composite major adverse cardiac events (MACE; all-cause death, myocardial infarction, any revascularisation).
Results |
r-LVR occurred in 466 patients (37.7%) and was associated with maximum troponin, door-to-balloon time, direct arrival to PPCI-capable hospital, coronary disease extent, initial left ventricular ejection fraction (LVEF), and LVESV. After propensity score (PS)-matching, initial LVEF and LVESV remained significant. During a median 403-day follow-up, 2-year MACE occurred in 166 patients (13.4%); its frequency was similar between groups (entire cohort: 13.5% vs. 13.4%, p=0.247; PS-matched: 11.8% vs. 11.8%, p=0.987). Kaplan-Meier estimates showed that MACE-free survival was comparable between groups (entire cohort: 86.5% vs. 86.6%, log rank p=0.939; PS-matched: 88.2% vs. 88.2%, log rank p=0.867). In Cox proportional hazard analysis, r-LVR was not associated with MACE (entire cohort: hazard ratio [HR] 1.018, 95% confidential interval [CI] 0.675–1.534, p=0.934; PS-matched: HR 1.001, 95% CI 0.578–1.731, p=0.999).
Conclusion |
We identified independent predictors of r-LVR and showed that while r-LVR occurred in 38% of our patients, it was not associated with clinical outcomes.
Le texte complet de cet article est disponible en PDF.Keywords : ST-elevation myocardial infarction, Primary percutaneous coronary intervention, Reverse left ventricular remodelling, Outcome
Plan
Vol 27 - N° 2
P. 154-164 - février 2018 Retour au numéro
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