Doğaç Okşen1, Mert Sarılar1, Gürsu Demirci1, İsmail Haberal2, Okay Abacı1

1Departmant of Cardiology, İstanbul University Cerrahpaşa Cardiology Institute, İstanbul, Turkey
2Departmant of Cardiovascular and Thoracic Surgery, İstanbul University Cerrahpaşa Cardiology Institute, İstanbul, Turkey

Keywords: Angioplasty; myocardial infarction; reperfusion; myocardial revascularization; in hospital mortality


Introduction: 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; 10.3% of the patients were Killip class III or IV. The mean door-to-device time was 43 (29-52) 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 49.5 (25-73) months follow-up, 12.4% of them died, 12.5% had a 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.

Ethics Committee Approval

The approval for this study was obtained from İstanbul University Cerrahpaşa Rectorate Cardiology Institute Ethics Committee (Decision no: B 08.06 YOK 2.İ.Ü.E., Date: 10.04.2019)

Peer Review

Externally peer-reviewed.

Author Contributions

Concept/Design - DO, OA; Analysis/Interpretation - DO, OA; Data Collection - MS, GD; Writing - DS OA, İH; Critical Revision - OA, İH; Final Approval - DO, OA; Statistical Analysis - MS, DO, OA; Overall Responsibility - OA, DO.

Conflict of Interest

The authors declared that there was no conflict of interest during the preparation and publication of this article.

Financial Disclosure

The authors declared that this study has received no financial support.