Predictors of death and reinfarction at 30 days after primary angioplasty:The GUSTO IIb and RAPPORT trials

Background Thirty-day death among recipients of fibrinolytic therapy for ac ute myocardial infarction (MI) is tightly correlated with easily obtainable key demographic and clinical parameters such as age, blood pressure, heart rare, and infarct location. Similar data for primary angioplasty are not a vailable. Methods and Results Data from 2 large, contemporary, primary angioplasty tr ials were formally combined and analyzed with respect to death and death/re peat MI at 30 days through the use of multivariate logistic regression mode ls. The 1048 patients had a median age of 62 years, and 26% were women. Thi rty-eight percent had an anterior infarction. The patients underwent angiop lasty at a median delay from symptom onset of 3.8 hours. Death was independ ently predicted by increasing age (adjusted odds ratio [OR] per decade 2.32 , 95% confidence interval [CI] 1.60 to 3.42), whereas a history of smoking (OR 0.29, Ct 0.13 to 0.64), Thrombolysis in Myocardial Infarction (TIMI) fl ow grade 3 after angioplasty (OR vs TIMI <3 0.21, CI 0.10 to 0.45) and high er systolic blood pressure (OR per 10 mm Hg 0.73, CI 0.62 to 0.87) were ass ociated with lower mortality rates. Death or repeat MI was independently as sociated with increasing age (OR per decade 1.40, CI 1.13 to 1.76) and ante rior location of the index MI (OR 1.89, CI 1.12 to 3.20). TIMI grade 3 flow (OR vs TIMI <3 0.40, CI 0.23 to 0.68) and higher systolic blood pressure ( OR per 10 mm Hg 0.79, CI 0.71 to 0.89) were associated with a lower inciden ce of death/repeat MI. Time to angioplasty, heart rate, extent of coronary artery disease, participation in 1 of the 2 trials, and all common coronary risk factors did not significantly predict outcome. Conclusions Death and reinfarction after primary angioplasty are predominan tly predicted by age, hemodynamic instability, and the attainment of TIMI 3 flow in the infarct artery.