Impact of hypertension history on short and long-term prognosis in patients with acute myocardial infarction treated with percutaneous angioplasty: comparison between STEMI and NSTEMI.

Previous studies analyzing the impact of hypertension (HTN) on myocardial infarction (MI) outcome reached conflicting results and scarce data are available in patients treated with percutaneous coronary intervention (PCI). In this study the prognostic impact of HTN history in ST-elevation MI (STEMI) and Non-STEMI (NSTEMI) patients treated with PCI was analyzed. We compared characteristics of 1,031 STEMI and 437 NSTEMI patients, in relation to the presence of HTN. Median follow-up duration was 40.2 months. HTN was significantly higher in NSTEMI vs. STEMI patients (p < 0.001). NSTEMI patients were older, with higher values of left ventricular ejection fraction (LVEF) and more frequently with previous myocardial revascularization than STEMI patients either among hypertensives and non-hypertensives. At univariate analysis HTN resulted associated with long-term mortality in STEMI but not in NSTEMI patients. At multivariate analysis HTN was not associated with either in-hospital and long-term mortality in both NSTEMI and STEMI group. In conclusion, in the PCI era HTN does not influence MI patients prognosis; other factors, such as age, admission LVEF, coronary disease extension, previous MI and creatinine levels are independently associated with MI patients outcome even though this should not discourage from a strict control of HTN after the acute event.

Early outcome after paclitaxel-eluting stents in patients with acute and subacute myocardial infarction. A clinical study.

BACKGROUND: Paclitaxel-eluting stents (PES) have been proven to prevent in-stent restenosis in patients submitted to elective percutaneous coronary intervention. No data are so far available about the safety and efficacy of PES in acute and subacute myocardial infarction. The aim of the present investigation was to evaluate the occurrence of in-hospital adverse events in patients with acute and subacute myocardial infarction submitted to PES implantation. METHODS: From June 1 to July 31, 2003, we implanted 53 PES in 43 consecutive patients with acute (34 patients) and subacute (9 patients) myocardial infarction. RESULTS: In 65.1% of the patients the culprit lesion was located in the left anterior descending artery. Direct stenting was performed in 27.9% and glycoprotein IIb/IIIa inhibitors were used in 74.4%. Before the procedure a TIMI flow 0-1 was present in 46.5% while post-procedural TIMI flow 3 was achieved in all patients. A pre-procedural TIMI thrombus grade 2 to 5 was present in 67.8%. No death, reinfarction, early post-infarction angina or any other episode referable to in-stent thrombosis were observed during hospitalization. No patient was submitted to target lesion revascularization. At short-term follow-up with a mean duration of 118 +/- 75 days from discharge no cardiac or noncardiac death, reinfarction or any other major adverse coronary events were reported in the study population and no target lesion revascularization was performed. CONCLUSIONS: In this study, PES implant in patients with acute and subacute myocardial infarction was safe, with an early outcome comparable to conventional standard stents and no adverse events related to acute or subacute thrombosis.