In-hospital and long-term outcomes of ST-segment elevation myocardial infarction patients undergoing primary percutaneous coronary intervention
1Istanbul University Cerrahpasa Cardiology Institute, Cardiology, Istanbul, Turkey
2Istanbul University Cerrahpasa Cardiology Institute, Cardiovascular And Thoracic Surgery, Istanbul, Turkey
Keywords: angioplasty, hospital mortality, percutaneous coronary intervention, prognosis, st-segment elevation myocardial infarction
Objectives: We evaluated in-hospital and long-term outcomes of patients who underwent primary percutaneous coronary intervention (PCI) in a tertiary center.
Patients and Methods: We examined 1550 patients (mean age: 58.5 years, 83.1% male) admitted with acute ST-segment elevation myocardial infarction (AMI) who underwent primary PCI and were followed-up prospectively. The primary outcomes were in-hospital death and major adverse cardiac events (MACE) at follow-up.
Results: The mean duration of ischemia at admission was 2.85 ± 2.49 hours; and the mean door-to-device time was 43.2 ± 20.3 minutes. During hospitalization, all-cause mortality occurred in 73 patients (4.7%). Multivariate analysis revealed that advanced age, impaired left ventricular ejection function, high Killip functional class, hemoglobin level at admission, ventricular arrhythmias, and advanced atrioventricular block were independent predictors of poor prognosis (OR: 1.07, 0.93, 15.34, 1.44, 3.79, and 4.26, respectively). Among discharged patients with a median follow-up of 49.5 (25‒73) months, 12.4% experienced all-cause mortality, 12.5% had recurrent myocardial infarction (MI), and 2.3% had a cerebrovascular accident. The strongest independent MACE predictors were impaired left ventricular function, poor glomerular filtration rate, low albumin level, and a history of cerebrovascular disease (HR: 0.97, 0.99, 0.65, and 2.50, respectively). Secondary outcomes were contrast-induced acute kidney injury (16.7%), ventricular arrhythmias (6.1%), advanced atrioventricular block (3.7%), atrial fibrillation (7.6%), and major bleeding (1.6%).
Conclusion: AMI still has a poor long-term prognosis. These results emphasize the advantages of rapid, non-delayed revascularization. Patients should be followed-up closely after discharge in both the short- and long-term.