The perfusion clinical syndrome: a new prognostic index in acute myocardial infarction

pp 549-554

Abstract

With the aim to know the independent prognostic value of reperfusion clinical syndrome (RCS) 164 consecutive patients with AMI who received thrombolytic treatment (TT) within 6 hours of onset of symptoms were studied. The RCS was defined by the presence of at least two of the following criteria two hours after TT: 1) significant relief of pain (a five point reduction in a one to ten subjective score); 2) ≥ 50 % reduction of summatory of ST segment elevation; 3) abrupt initial increase of CK levels (more than two-fold over the upper-normal or baseline elevated values). By means of bivariate analysis the r of Pearson correlation coefficient was obtained for the association between inhospital mortality and the following clinical variables: sex, age, previous history of hypertension, diabetes, and myocardial infarction, acute or chronic anginal prodromes (< or > than one month), systolic pressure at admission, Killip-Kimball index at admission (Ka) and maximum during hospital stay (Km), Peel (P) index and RCS. In order of signi- ficance the Km (r = 0.598; P < 0.001), Peel index (r = 0.457; P < 0.001), Ka (r = 0.351; P < 0.001), RCS (r=0.283); p<O.OOI) and age (r=0.190; p<0.05) were associated with mortality. By multivariate analysis (logistic regression) maximum Killip-Kimball index (p < 0.0001), age (p = 0.01) and the absence of RCS (r =0.02) were independent predictors of mortality. The presence of RCS defined a group of patients with significant lower mortality (odds ratio: 0.20; 95 % confidence interval: 0.05-0.87). In conclusion, the age and the hemodynamic impairment were main determinants of inhospital outcome. In view of his independent value, the RCS may by used as a new prognostic index to identify a higher risk group of patients in which a more interventional post-thrombolysis strategy could be tested. Our results suggest that the RCS could be routinely adopted in the evaluation an management of AMI patients in the thrombolytic era.