Primary Percutaneous Coronary Intervention in Acute Myocardial Infarction: Long-Term Predictors of Adverse Events

pp. 359-365

Abstract

Introduction: Acute myocardial infarction (AMI) is one of the leading causes of cardiovascular death. Reperfusion treatments performed within the first hours have contributed to a significant reduction in mortality. In our country, there are no long-term follow-up registries of AMI patients treated with primary percutaneous coronary intervention (PCI).
Objectives: To evaluate the in-hospital results and long-term outcome of ST-segment elevation AMI (STEMI) patients undergoing primary PCI and their correlation with the main clinical and therapeutic variables applied in different decades (1993-2002 vs. 2003-2012).
Methods: An observational and retrospective study of all STEMI patients undergoing primary PCI in two community hospitals between 1993 and 2012 was performed.
Results: The study included 851 patients consecutively admitted between 1993 and 2012. Mean age was 61 ± 12 years and median follow-up was 7.8 years in 85% of the population. In-hospital mortality was 6% and 1.6% when patients with shock at admission were excluded. Mortality was independently associated with age (OR 1.06, CI 1.03-1.09; p < 0.001), female sex (OR 3.1, CI 1.5-6.2; p < 0.002), diabetes mellitus (OR 3.9, CI 1.86-8; p < 0.001) and three-vessel disease (OR 4.3, CI 2.1-8.6; p < 0.001). Conversely, final TIMI grade 3 flow predicted lower in-hospital mortality (OR 0.28, CI 0.08-0.11; p < 0.008). During follow-up, overall mortality was 14.3% and independent predictors were age (OR 3.1, CI 1.8-5.5; p < 0.001), diabetes mellitus (OR 2.3, CI 1.25-4.3; p < 0.007) and Killip and Kimball (KK) class C or D at admission (OR 4, CI 1.7-9; p < 0.001); stent implant was associated with lower overall long-term mortality (OR 0.35, CI 0.21-0.6; p < 0.001).
Conclusions: In this group of STEMI patients, adequate use of primary PCI and high follow-up rates allowed the collection of favorable in-hospital and long-term results. Advanced age at STEMI, diabetes mellitus, female sex and multiple vessel disease were predictors of in-hospital mortality, while age, diabetes mellitus and KK class C or D were independent predictors of long-term mortality. Patients treated during the second decade showed a non-significant trend towards reduced in-hospital mortality compared with those of the first decade.