Percutaneous Coronary Intervention and 1-Year Survival in Patients Treated With Fibrinolytic Therapy for Acute ST-Elevation Myocardial Infarction

Abstract

Aims To assess the predictors of 1 year mortality in patients treated with fibrinolytic therapy for ST-segment elevation myocardial infarction (STEMI) and to determine whether a strategy of early percutaneous coronary intervention (PCI) improves outcome. Methods and results Consecutive patients (n ¼ 474) admitted to our unit (1998–2001) with STEMI were treated with fibrinolytic therapy. For each patient, age, gender, admission via mobile coronary care unit (MCCU), infarct location, initial systolic blood pressure and Killip class, prior history of ischaemic heart disease, hypertension, diabetes mellitus, smoking status, family history, hyperlipidaemia, and in-hospital PCI (n ¼ 154) were recorded. Mortality at 1 year was obtained from medical records (n ¼ 473). Binary logistic regression analysis was performed to determine independent predictors of 1 year mortality. Mortality in the non-PCI group was 21 vs. 7% in the PCI group. Independent predictors of 1 year mortality were age (risk ratio 1.12, 95% CI 1.08–1.15, P , 0.0001), initial SBP � 80 mmHg (risk ratio 4.34, 95% CI 1.68–11.2, P ¼ 0.002), initial Killip class � 3 (risk ratio 2.97, 95% CI 1.42–6.2, P ¼ 0.004), and lack of in-hospital PCI (risk ratio 0.39, 95% CI 0.19–0.81, P ¼ 0.012). Although the PCI group were younger (P ¼ 0.007), more likely to be admitted via the MCCU (P ¼ 0.008), with a shorter pain to needle time (P ¼ 0.04), multivariable analysis adjusted for these differences. Conclusion In-hospital PCI in patients treated with fibrinolytic therapy for STEMI is associated with a substantial reduction in 1 year mortality.