Resumen

HAMDAN, Nabil et al. Incidence and clinical signification of myocardial perfusion degree during primary angioplasty in patients with acute myocardial infarction. Rev. Col. Cardiol. [online]. 2006, vol.13, n.3, pp.154-164. ISSN 0120-5633.

Introduction and objectives: a variable percentage of patients with myocardial infarction treated with primary percutaneous coronary intervention have myocardial perfusion involvement, in spite of reestablishing the epicardium coronary flow. In this study, the relation between the grade of myocardial perfusion and the probability of clinical events such as angina, cardiac failure or the re-admission due to cardiac causes and intra-hospitalary death and that occurred after six months, are evaluated. Materials and methods: in 86 patients with acute myocardial infarction treated with primary percutaneous coronary intervention, the angiographic and clinical results were compared according to the grade of myocardial perfusion. In all of them, during the hospitalization, the cardiac enzymes’ levels were evaluated, an electrocardiogram in the first two hours after the percutaneous coronary intervention was performed, and the ventricular function was observed through echocardiography. Six months clinical follow-up was realized in 80 patients (93%) and clinical events such as angina, heart failure, re-admission due to cardiac causes and death were evaluated. Results: no angina was observed in the different groups treated with primary percutaneous coronary intervention during the hospitalization. Heart failure occurred in 3 patients (23.1%) from the 0-1 grade group of myocardial perfusion and in none from the grade 3 group of myocardial perfusion (p<0.01). There were 2 deaths (13.3%) in the group with 0-1 grade of myocardial perfusion and none in the group with grade 3 of myocardial perfusion (p=0.01). Seven patients (63.9%) from the group with degree 0-1 of myocardial perfusion and 2 patients (5%) from the group with myocardial perfusion grade 3 (p=0.01) developed heart failure. 7 patients (41.2) were re-hospitalized due to cardiac causes, with myocardial perfusion grade 0-1 and 2 patients (6.9%) with myocardial perfusion grade 3 (p < 0.01). Death occurred in 3 patients (27.3%) with myocardial perfusion grade 0-1 and in 1 patient (3.3%) with myocardial perfusion grade 3 (p=0.10). Conclusion: evaluation of myocardial perfusion grade allows to stratify the risk of clinical events and mortality in patients with acute myocardial infarction treated through primary percutaneous coronary intervention, both intra-hospitalary and six months after. In patients with acute myocardial infarction treated with primary percutaneous coronary intervention, we found that the grade of myocardial perfusion 0-1 predicts in direct way mortality and cardiovascular events.

Palabras clave : acute myocardial infarction; primary angioplasty; coronary stent; grade of myocardial perfusion.

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