Five-Year Outcomes of Patients With ST Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention at Auckland City Hospital

Abstract

Aim: When able to be provided in a timely manner, as is possible and routinely performed in Auckland, primary percutaneous coronary intervention (PCI) is the standard-of-care for patients with ST-elevation myocardial infarction (STEMI). There are limited real world data on longer-term outcomes after primary PCI with second generation drug-eluting stents (DES) Methods: All patients presenting to Auckland City Hospital with STEMI in 2012, and undergoing emergency primary PCI, were identified. Case notes, electronic records were reviewed, supplemented with data from national statistical collection. Results: 399 patients (mean age 65+/-18, 274 (76%) male) were identified. Of these 51 were in cardiogenic shock at presentation. 35 patients (8.7%) of whom presented in shock, died during hospitalisation. Patients received a mean 1.4 DES. Median door to reperfusion time was 90 minutes. Of those discharged alive, all-cause mortality, at a median follow-up of 4.7 years, was 9.7% and the cardiac mortality was 3.6%. 31 patients (8%) had recurrent symptoms leading to repeat coronary angiography. Thrombotic stent occlusion and in-stent restenosis occurred in only 1 and 7, respectively (8 patients, 2.2%, in total). The only significant factor associated with re-presentation was medication non-compliance, 6 (19%) versus 12 (3.2%) in the remainder. Conclusion: In patients with STEMI and cardiogenic shock, early mortality rates remain high despite low reperfusion times. Of those surviving to discharge, 5-year outcomes are good with most deaths from non-cardiac causes, and low rates of stent thrombosis and restenosis after PCI with second generation DES.