343 Does grade 3 ischemia on admission electrocardiogram predicts failure of myocardial reperfusion after coronary angioplasty for acute myocardial infarction

Failure of myocardial perfusion after coronary angioplasty for acute myocardial infarction (AMI) is associated with a poor prognosis. Grade 3 ischemia (G3I) was shown to be associated with failure of myocardial perfusion. Aim Evaluate the prognosis impact of G3i, recorded on the admission electrocardiogram, after percutaneous coronary intervention (PCI) for AMI. Methods One hundred eight patients had PCI in the setting of AMI. G3I was defined as: Absence of S wave below the TP-PR isoelectric line in > 2 leads. Patients meeting the ST-elevation criteria but not the G3I criteria were classified as grade 2 ischemia (G2I). Myocardial perfusion was evaluated on ST-segment resolution and angiographyally on the flow of infarct-related artery graded according to the TIMI scale. Occurrence of no-reflow, no ST-segment resolution and hospital mortality were evaluated. Results Patients were divided in 2 groups: G3I (51 patients) and G2I. (57 patients). Clinical and angiographic characteristics were similar, absence of ST-segment resolution; the no-reflow phenomena and hospital mortality were more common in the G3I group respectively: 47% vs 20% (p= 0.002), 27% vs 10% (p = 0,024) and 21,.6% Vs 8.8% (p = 0.062). IG3, female gender, diabetes and delay to consultation > 2 hours were associated with the occurrence of no-reflow, persistence of ST- segment elevation and hospital death. In multivariate analysis, IG3 was an independent factor of no-reflow and absence of ST- segment resolution: OR 3.45 (CI 95% [1.15 to10.31]) p=0.027 and OR 3.47 (CI 95% [1.37 to9.01]) p=0.011, respectively. Female gender, no-reflow and persistence of ST-segment elevation were the only independent predictive factors of hospital mortality, respectively : OR 10,59 (CI 95% [1,68 to66,8]) p=0,012 ; OR 7,39 (CI 95% [1,52 to35,8]) p=0,013 ; OR 50 (CI 95% [4,69 to532]) p=0,001 but not the grade 3 ischemia. Conclusion Grade 3 ischemia on the admission electrocardiogram of acute myocardial infarction is a strong independent predictors of failure of tissular reperfusion.