018 Immediate and 12 month outcomes of interventional reperfusion strategy in acute ST elevation myocardial infarction at a developing country hospital. Compared to the west, can good results be achieved?

Abstract

Percutaneous coronary intervention (PCI) has been proven to be the treatment of choice in acute ST-elevation myocardial infarction (STEMI) in the west world. There is limited adoption and a paucity of data on outcomes following PCI in developing countries. The objective of this study was to describe the procedural and clinical outcomes of patients undergoing PCI for STEMI at a university hospital in Tunisia and make a comparison with outcomes from the West. We conducted a retrospective cohort study at a tertiary care university hospital in Tunis, Tunisia. A total of 209 consecutive patients undergoing PCI between January 2005 and June 2007 were reviewed. cox proportional hazards models were constructed. The primary outcome was mortality: in-hospital, 30 days, and 12-month later. The mean patient's TIMI score was 3.8+0.2 (10% were in cardiogenic shok). Procedural success was 75.5%. In-hospital, 30 days and 12 months mortality were respectively 5.3%, 6.7% et de 8.2%, comparing favorably with TIMI's score predicted mortality and the published registries from developed countries. Multivariate predictors of in-hospital death included (hazards ratio, 95% confidence interval) age>70 years, mutivessel disease and PCI failure. Multivariate predictors of 12 months death were killip III-IV status at admission and PCI failure. We conclude that, despite the logistic difficulties, excellent outcomes for acute interventional reperfusion strategy in STEMI can be achieved in a developing country, possibly similar to those seen in the West. There is a strong need for making the practice of PCI in STEMI more widespread in developing regions.