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Beneficial effect of reperfusion therapy beyond the preservation of left ventricular function in patients with acute ST-segment elevation myocardial infarction

Background - Reperfusion therapy has been shown to improve mortality in patients with acute ST-segment elevation myocardial infarction. However, in randomized clinical trials there was only a modest improvement in left ventricular ejection fraction with reperfusion therapy, despite a larger improvem...

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Main Authors: Zeymer, Uwe (Author) , Bauer, Timm (Author) , Gersh, Bernard J. (Author) , Zahn, Ralf (Author) , Gitt, Anselm Kai (Author) , Jünger, Claus Heinrich (Author) , Senges, Jochen (Author)
Format: Article (Journal)
Language:English
Published: 2011
In: International journal of cardiology
Year: 2011, Volume: 146, Issue: 2, Pages: 177-180
ISSN:1874-1754
DOI:10.1016/j.ijcard.2009.06.034
Online Access:Verlag, lizenzpflichtig, Volltext: https://doi.org/10.1016/j.ijcard.2009.06.034
Verlag, lizenzpflichtig, Volltext: https://www.sciencedirect.com/science/article/pii/S0167527309007086
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Author Notes:Uwe Zeymer, Timm Bauer, Bernard J. Gersh, Ralf Zahn, Anselm Gitt, Claus Jünger, Jochen Senges
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Summary:Background - Reperfusion therapy has been shown to improve mortality in patients with acute ST-segment elevation myocardial infarction. However, in randomized clinical trials there was only a modest improvement in left ventricular ejection fraction with reperfusion therapy, despite a larger improvement in mortality. - Methods - In the prospective MITRA-Plus registry we compared 1-year mortality of inhospital survivors of ST-segment elevation myocardial infarction (STEMI) divided into nine groups with preserved (>55%), moderately reduced (41-55%) and severely reduced (≤40%) left ventricular ejection fraction (LVEF) and treated with no early reperfusion therapy, fibrinolysis or primary percutaneous coronary intervention (PCI) within 24h after admission. - Results - A total of 5867 patients were included in this analysis, 1026 (18%) without early reperfusion, 2462 (42%) with fibrinolysis and 2379 (40%) with primary PCI. After adjustment for confounding variables in a propensity score analysis, reperfusion therapy (Odds ratio and 95% CI: 0.27, 0.15-0.48; 0.50, 0.32-0.79; 0.64, 0.44-0.93), fibrinolysis (Odds ratio and 95% CI: 0.27, 0.14-0.52; 0.58, 0.35-0.95; 0.60, 0.39-0.93) and primary PCI (Odds ratio and 95% CI: 0.22, 0.11-0.44; 0.34, 0.19-0.59; 0.56, 0.36-0.88) remained independent predictors of survival in comparison to no reperfusion therapy in the patients with preserved, moderately reduced and severely reduced LVEF, respectively. - Conclusions - These results suggest a beneficial effect of early reperfusion therapy beyond the preservation of left ventricular function, however the mechanisms need further study.
Item Description:Available online: 14 July 2009
Gesehen am 22.12.2022
Physical Description:Online Resource
ISSN:1874-1754
DOI:10.1016/j.ijcard.2009.06.034

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