Prediction of long-term outcome after primary percutaneous coronary intervention for acute anterior myocardial infarction

Background: Despite the widespread use of reperfusion methods, the long-term outcome after primary percutaneous coronary intervention (PCI) is variable, and accurate risk stratification is of clinical importance. Aim: To assess the predictors of long term outcome after PCI for acute anterior myocardial infarction (AMI). Methods: One hundred and twenty-seven consecutive patients undergoing PCI within 12 hours from the onset of the first AMI were enrolled. Troponin I, CK-MB, creatinine, NT-proBNP, echocardiographic left ventricular (LV) function, myocardial contrast perfusion, results of coronary angiography, ECG, 24-hour Holter ECG, and T-wave alternans (TWA) were analysed as predictors of major adverse cardiac events (MACE), defined as death, non-fatal reinfarction, sustained ventricular tachycardia, and rehospitalisation for decompensated heart failure. Patients were followed up for two years. Results: Twenty-seven patients developed MACE. The best predictive model for MACE consisted of impaired perfusion (MCE, myocardial contrast echocardiography), higher CK-MB at 24 hours, discharge NT-proBNP, and non-negative TWA. The combination of elevated creatinine level, decreased LV ejection fraction, and a non-negative TWA proved the best for identification of patients at risk of cardiac death. The best multivariate model for predicting heart failure hospitalisation consisted of higher 24-hour CK-MB, discharge NT-proBNP, impaired perfusion and prolonged duration of ST elevation. Conclusions: Our study showed that the rate of MACE in patients with anterior ST-segment elevation myocardial infarction undergoing primary PCI at two years follow-up is low. A combined assessment of myocardial contrast. perfusion, TWA, CK-MB and discharge NT-proBNP seems to optimally predict patients at risk of MACE.