Michael W. Yerkey

The incidence, predictors, and outcomes of early reinfarction after primary angioplasty for acute myocardial infarction.

OBJECTIVES We sought to identify the incidence, predictors, and clinical consequences of one-month reinfarction (RE-MI) in patients undergoing primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI). BACKGROUND One-month reinfarction after AMI significantly increases long-term mortality; however, little is known about the incidence and predictors of RE-MI in patients undergoing primary angioplasty. METHODS We analyzed data from 3,646 patients who underwent primary PCI in the Primary Angioplasty in Acute Myocardial Infarction (PAMI) studies. We studied the incidence, correlates, and clinical outcomes of 30-day RE-MI. RESULTS Reinfarction within one month of index hospitalization occurred in 77 (2.1%) of patients. In multivariate analysis, admission Killip class >1 (odds ratio [OR] 2.02, 95% confidence interval [CI] 1.09 to 3.76), left ventricular ejection fraction <50% (OR 2.49, 95% CI 1.30 to 4.74), final coronary stenosis >30% (OR 2.57, 95% CI 1.28 to 5.15), and presence of coronary dissection (OR 2.40, 95% CI 1.36 to 4.24) and thrombus (OR 2.36, 95% CI 1.23 to 4.53) on the final angiogram were independent correlates of RE-MI. One-month reinfarction was independently associated with death (OR 7.14, 95% CI 3.28 to 15.5) and ischemic target vessel revascularization (I-TVR) (OR 15.0, 95% CI 8.68 to 26.0) at six months. CONCLUSIONS We conclude that, although early RE-MI is uncommon in patients treated by primary PCI, it is a significant independent predictor of death and I-TVR at six months. Admission Killip class >1 and left ventricular systolic dysfunction were associated with higher incidence of RE-MI. Our results suggest that optimal revascularization during primary PCI may decrease RE-MI rates.

Usefulness of Breast Arterial Calcium Detected on Mammography for Predicting Coronary Artery Disease or Cardiovascular Events in Women With Angina Pectoris and/or Positive Stress Tests

Breast arterial calcium (BAC) has been suggested as a marker and predictor of cardiovascular risk and coronary artery disease (CAD). However, an association between BAC and these cardiovascular end points has not been fully elucidated in patients undergoing cardiac catheterization. Consecutive patients undergoing mammography and cardiac catheterization within a 36-month period were retrospectively evaluated through chart review. Cardiac catheterization films and mammograms from 94 patients were independently reviewed for the presence of CAD and BAC, respectively. Cardiovascular risk factors, history of revascularization, and history of myocardial infarction were compared between women with and without BAC. BAC was more prevalent in older women (mean age 69 + or - 10 vs 63 + or - 11 years, p = 0.02). Aside from an inverse correlation with smoking, there was no difference in the presence of CAD or cardiovascular risk factors between patients with and without BAC. Patients with BAC had a lesser history of acute myocardial infarction (21% vs 41%, p <0.05) and were less likely to undergo revascularization (23% vs 43%, p <0.05). In conclusion, BAC was not positively associated with cardiovascular risk factors, documented CAD, or acute cardiovascular events, suggesting that the presence of BAC as determined by mammography is not a useful predictor of CAD in intermediate- to high-risk patients.

Percutaneous atrial septostomy for urgent palliative treatment of severe refractory cardiogenic shock due to right ventricular infarction.

We report a novel palliative treatment to improve refractory cardiogenic shock due to right ventricular ischemia. We performed percutaneous atrial septostomy to create an atrial septal defect, which resulted in immediate right ventricular decompression and increased left ventricular filling associated with prompt and dramatic hemodynamic and clinical improvement. Cathet Cardiovasc Intervent 2003;59:44–48.