Influence of vessel size on early and late outcomes after primary angioplasty for acute myocardial infarction

Small vessel size is associated with worse outcomes after elective angiopla sty, but the effect of vessel size on outcomes after primary angioplasty fo r acute myocardial infarction has not been studied. We evaluated outcomes i n 1,490 consecutive patients treated with primary angioplasty comparing pat ients with small (< 3.0 mm) versus Large (greater than or equal to 3.0 mm) vessels. Outcomes were worse in patients with small vessels,vith lower proc edural success rates (92% versus 96%; p = 0.002), higher rates of reinfarct ion (5.5% vs. 3.4%; p = 0.07), more late reocclusion (12.5% vs. 4.1%; p = 0 .002), less improvement in ejection fraction (1.8% vs. 4.2%; p = 0.04), low er follow-up ejection fraction (53.7% vs. 56.5%; p = 0.03), and higher 30-d ay and late mortality (12.5% vs. 6.4%; p = 0.0002). The higher mortality ca n be explained by a higher baseline risk profile combined with worse proced ural results and higher rates of reocclusion and reinfarction. These data s tress the importance of developing new strategies to improve procedural and late outcomes after primary angioplasty in patients with small vessels.