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

José Alvarez, Guillermo Migliaro, Gustavo Leiva, Jorge Allin, Pablo Baglioni, Maria Luz Fernandez Recalde, Horacio Avaca, Felipe Deketele

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.

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Revista argentina de cardiología. ISSN en línea 1850-3748. Argentine journal of cardiology (English ed. Online ISSN 2314-2286) Sociedad Argentina de Cardiología. Azcuénaga 980 (C1115AAD),Ciudad Autónoma de Buenos Aires, República Argentina. Tel. (54 11) 4961-6027/8/9 Fax: 4961-6020 www.sac.org.ar revista@sac.org.ar