Indicators of long term prognosis after primary percutaneous coronary intervention for ST segment elevation myocardial infarction

Aim and Rationale: The purpose of the study is to determine conventional risk factors in patients who referred to hospital with STEMI that we performed successful PPKG. Additionnally the study aims to determine the effect of the time period to reperfusion ( symptom and door-to-baloon time); serum glucose level, renal function tests, full blood count checked in emergency service and echocardiographic results on major adverse cardiac events. Reinfarction, cardiovascular related hospitalization, mortality and composite end point were defined as major adverse cardiac events.Method and Material: We included 260 patients into the study who applied to ?Dokuz Eylül University Medical Faculty Hospital (DEÜTF)? emergency service between January 2003 and December 2007 with STEMI and performed successful PPCI by DEÜTF Department of Cardiology. The patients age range between 21 and 89. Median follow-up time is 37,7 months. The patients data, symptom and door-to-baloon time retrospectively noted from archive records of DEÜTF Medical Faculty Hospital. From the emergency service data serum blood glucose level, serum creatinin, sodium, potasium and chlor levels and 15 parameters of full blood count are recorded. Left ventricle ejection fraction, cardiac chamber diameters considered in echocardiographic examinations. Reinfarction, cardiovascular related hospitalization and cardiovascular related mortality accepted as major cardiac adverse events. We investigated the effects of the datas on major cardiac adverse events and composite endpoint.Results: In cardiovascular related hospitalization group hyperlipidemia and hypertension are more frequent. We couldn?t find statistically significant difference in parameters obtained in echocardiographic examination made after PPCI but in control echocardiographic examination left ventricle ejection fraction found significantly decreased. In females, older than 65 years-old, whom have hypertension and hyperlipidemia the survival determined significantly decreased. We foud that symptom time, serum blood glucose level and creatinin level, white blood cell and neutrophile levels in full bood count are risk factors for hospitalization and we didn?t find any effect of door-to-baloon time on hospitalization. In echocardiographic examinations decreased left ventricle ejection fraction, increased left ventricle and left atrium diameters found as a risk factors for hospitalization.In reinfarction group there was no significant difference beside hypertension. In echocardiographic examination of the patient who have and haven?t reinfarction; left ventricle ejection fraction of the patients who have reinfaction determined significantly decreased. Between these groups there was no significant difference in symptom and door-to-baloon time, biochemical and hematological parameters. Hypertension, family history, red blood cell count, low left ventricle ejection fraction determined as risk factors for reinfarction.In cardiovascular related mortality group diabetes mellitus, hypertension, smoking and family history determined more frequent in patients who suffered cardiovascular related mortality. Patients who suffered cardiovascular related mortality were more elder, have longer symptom time, have higher serum glucose, creatin levels and higher white blood cell, neutrophil, hemoglobin levels. Their left ventricle ejection fraction were lower and left ventricle and atrium were larger. In survival analysis age, diabetes mellitus, smoking, family history, symptom time, serum glucose, creatin level, white blood cell, neutophil and thrombocyte levels are determined as risk factors for cardiovascular related mortality. In echocardiographic examinations left ventricle ejection fraction, left ventricle and atrium dilatation found related to cardiovascular mortality. At the composite endpoint (reinfarction, hospitalization, mortality) hypertension, diabetes mellitus, smoking, family history, age more than 65 years-old reduces survival free from event. In risk analysis these factors determined as significant risk factors for composite endpoint. Symptom time more than 120 minutes is also a significant risk factor for composite endpoint but door-to-baloon time is inefficient. Serum glucose, creatin, increase in white blood cell found significant risk factors for composite endpoint.Conclusion: The effect of conventional risk factors in patients with STEMİ who treated successfully with PPCI on cardiovascular adverse events in short and long term manifested in this study. Symptom time which determines ischemic period, serum glucose, creatin levels and full blood count are important risk factors besides conventional risk factors.Key Words: ST segment elevation myocardial infarction, primary percutaneus intervention, cardiovascular adverse event.