Suboptimal Reperfusion in Patients with ST-Segment Elevation Acute Myocardial Infarction Treated with Primary Percutaneous Coronary Intervention: Predictors and Prognostic Value

espanolExiste evidencia que la reperfusion suboptima (RSO) tiene impacto pronostico a corto plazo en los pacientes con sindromes coronarios agudos con elevacion del segmento ST, pero hay poca informacion sobre los factores vinculados a la RSO. OBJETIVOS: Analizar los factores asociados a RSO en pacientes con infarto agudo de miocardio con elevacion del segmento ST (IAMCEST), tratados con angioplastia primaria. METODOS: Se analizaron los pacientes con diagnostico de IAMCEST que recibieron tratamiento de revascularizacion con angioplastia primaria en el registro SCAR (Sindromes Coronarios Agudos en Argentina). Se analizo la asociacion entre las variables clinicas clasicas, de laboratorio y el indice leucoglucemico (ILG) con la RSO. Se definio RSO como TIMI III angiografico post ATC con descenso del segmento ST en el ECG menor al 50%. RESULTADOS: Se analizaron 258 pacientes con IAMCEST, de los cuales 197 (76.4%) cumplieron los criterios de inclusion. De estos, el 8,6% (n:17) tuvieron RSO. La incidencia de muerte intrahospitalaria entre los pacientes con RSO fue del 17,6% (n:3) versus 1,7% (n:3) en aquellos sin RSO (p=0,007). En el analisis univariado las variables asociadas a RSO fueron: diabetes (OR: 3,2 (IC95% 1,09-9,43) p=0,026), revascularizacion previa (OR: 5,8 (1,74-19,07) p=0,008), ILG (> 2159) (OR 3,7 (1,32-10,22) p=0,009), y el tiempo dolor/balon (>159 minutos) (OR: 6.9 (0,88-53) p=0,045). El Killip-Kimbal 3-4 al ingreso, la edad >70 anos, el sexo masculino, la hipertension arterial, el tabaquismo, el infarto previo o anterior, y el flujo TIMI 0-1 al ingreso no fueron significativas. Previo al analisis se establecio por curva ROC el punto para el ILG asociado a RSO en 2159 puntos (VPN: 94%), y el de tiempo dolor/balon en 159 min (VPN: 96%). En la regresion logistica, solo la revascularizacion previa (OR: 5,3 (1,53 -18,55)) y el ILG (OR: 3,2 (1,11–9,28)) estuvieron asociadas a RSO. CONCLUSIONES: La RSO se asocio significativamente a mayor incidencia de muerte intrahospitalaria; mientras que la revascularizacion previa y el ILG (>2159) se asociaron a RSO. EnglishBackground: Although there is evidence that suboptimal reperfusion has short-term prognostic impact in patients with STsegmentelevation acute coronary syndromes, there is little information about its associated factors.Objectives: The aim of this study was to analyze the factors associated with suboptimal reperfusion in patients with acuteST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI).Methods: Patients from the SCAR (Acute Coronary Syndromes in Argentina) registry diagnosed with acute STEMI undergoingPCI were included in the study. The association of classical clinical and laboratory variables and the leuko-glycemic indexwith suboptimal reperfusion was analyzed. Suboptimal reperfusion was defined as post-PCI angiography TIMI III flow withless than 50% ST-segment decrease in the ECG.Results: Overall, 197 patients (76.4%) out of 258 patients with acute STEMI met the inclusion criteria. Among them, 8.6%(n: 17) had suboptimal reperfusion, with an incidence of in-hospital death of 17.6% (n: 3) versus 1.7% (n: 3) in patients withoutsuboptimal reperfusion (p=0.007). In the univariate analysis, variables associated with suboptimal reperfusion were: diabetes[OR: 3.2 (1.09-9.43) p=0.026], previous revascularization [OR: 5.8 (1.74-19.07) p=0.008], leuko-glycemic index (> 2,159) [OR3.7 (1.32-10.22) p=0.009], and pain-to-balloon time (>159 minutes) [OR: 6.9 (0.88- 53) p=0.045]. Age >70 years, male sex,high blood pressure, smoking, previous or anterior-wall infarction, and Killip and Kimball 3-4 and TIMI 0-1 flow on admissionwere not significantly different between patients with or without suboptimal reperfusion. Prior to the analysis, the cutoff pointfor the leuko-glycemic index associated with suboptimal reperfusion was established at 2,159 points by ROC curve analysis(NPV: 94%), and the pain-to-balloon time at 159 min (NPV: 96%). In logistic regression analysis, only previous revascularization[OR: 5.3 (1.53 -18.55)] and leuko-glycemic index [OR: 3.2 (1.11-9.28)] were associated with suboptimal reperfusion.