We included 101 patient diagnosed with first episode of ST-elevation acute myocardial infarction. Acute myocardial infarction was defined according to European society of cardiology guidelines. Inclusion criteria were also percutaneous coronary intervention performed within 12 hours of onset of chest pain and age between 18–79 years. The study was approved and overseen by the hospitals Ethics committee board. All patients were informed of the study details by one of the authors and signed a written consent form which was approeved and reviewed by the Ethics comitee board. We excluded patients with known cardiomyopathy (regardless of etiology), chronic renal insufficiency stage IV and V, and intolerance of lipophilic ACEI or ARB. All included patients received standard therapy for myocardial infarction (ACEI/ARB, beta-blocker, statin, acetylsalicylic acid, clopidogrel/ticagrelor).
All blood tests and vital parameters were collected at baseline, 6 and 12 hours following PCI. NTproBNP was also collected 1 year following PCI.
Transthoracic echocardiography was performed within 5 days from myocardial infarction and 1 year later. Pathological ventricular remodeling was defined as EDVi (left ventricular end-diastolic volume index) > 79 ml/m2 for men, or EDVi > 71 ml/m2 for women and/or ESVi (left ventricular end-systolic volume index) > 32 ml/m2 for men, and ESVi > 28 ml/m2 for women, according to normal reference ranges for cardiac chambers size from NORRE study (4).
Coronary angiography was performed within 12 hours from onset of chest pain. All procedures were performed with transradial approach. Only culprit lesion was revascularized during primary PCI, other significant lesions (evaluated by the operator who performed primary PCI) were revascularized within 3 months.
The covariates included were age, systolic blood pressure on admission, diastolic blood pressure on admission, Killip class on admission, heart rate on admission, culprit coronary artery, number of arteries with signficant stenosis (defined as > 70%), SYNTAX score, pain to baloon time, diabetes, weight, BMI, dyslipidaemia, smoking status, previous medical therapy, medical therapy on dismissal, hypertension, prior cerebrovascular disease, CK value at admission, 6 h post PCI and 12 h post PCI, hsTNI at admission, 6 h post PCI and 12 h post PCI, AST value at admission, 6 h post PCI and 12 h post PCI, ALT value value at admission, 6 h post PCI and 12 h post PCI, LDH value value at admission, 6 h post PCI and 12 h post PCI, glucose plasma value value at admission, 6 h post PCI and 12 h post PCI, HbA1C during hospitalisation, NTproBNP value value at admission, 6 h post PCI and 12 h post PCI, and 1 year after myocardial infarction.
Descriptive statistics was initially performed. Data distribution was analyzed by the Kolmogorov-Smirnov test. Most of the variables did not follow the normal distribution. Continuous variables were expressed as mean and standard deviation, but were analyzed by nonparametric tests. Independent samples were compared by the Kruskal-Wallis or Mann-Whitney test. Dependent continuous variables were analyzed by the Wilcoxon test. Categorical variables were compared by χ-square test with Yates correction. The analysis of the correlation between individual parameters was done by Spearman correlation and binary logistic regression. Binary logistic regression was also used to analyze the interrelationship of the variables and to correct the correlation for the disruptive factors. When performing multivariate analysis, a model of backward stepwise conditional regression was used. The aim of this model was to find out which independent variables are independently related to the dependent variable, and the same was used in all forms of regression. ESVi was used as a dependent variable in the multivariate analysis, and a maximum of 6 variables were used in each model, which is appropriate to the sample size. Only variables that showed a statistically significant difference in univariate analysis were included in the multivariate analysis. Since variables that do not follow the normal distribution were used in the multivariate analysis, all analyzes on logarithmically transformed data were repeated. Since the same results were obtained, only the results obtained by the analysis of "raw" data are shown. In order to relate the predictive value of each parameter that proved to be an independent predictive factor, a regression equation composed of non-standardized coefficients of multivariate analysis for each individual predictive factor was constructed. Finally, reciever operating characteristic (ROC) analysis was used to analyze the predictive value of an individual parameter, or regression equation in the prediction of elevated ESVi.
Statistical analysis was performed with SPSS software version 20.0. All of the tests were considered statistically significant if p-value < 0.05.