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

Abstract

performed within the first hours have contributed to produce a significant reduction in mortality. In our country, there areno long-term follow-up registries of AMI patients treated with primary percutaneous coronary intervention (PCI).Objectives: The aim of this study is 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 indifferent decades (1993-2002 vs. 2003-2012).Methods: We performed an observational and retrospective study of all STEMI patients undergoing primary PCI in two communityhospitals between 1993 and 2012.Results: The study included 851 patients consecutively admitted between 1993 and 2012. Mean age was 61 ± 12 years andmedian follow-up was 7.8 years in 85% of the population. In-hospital mortality was 6% and 1.6% when patients with shock atadmission were excluded. It 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 the independent predictors were age (OR 3.1, CI 1.8-5.5; p < 0.001), diabetes mellitus (OR2.3, 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 implantwas 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, the adequate use of primary PCI and the high rate of patients at long-termfollow-up allowed the collection of favorable in-hospital and long-term results. Advanced age at the moment of STEMI, diabetesmellitus, female sex and multiple vessel disease were predictors of in-hospital mortality, while age, diabetes mellitus and KKclass C or D were independent predictors of mortality during follow-up. Patients treated during the second decade showed anon-significant trend towards reduced in-hospital mortality compared with those of the first decade.