In-Hospital and Long-Term Outcomes of ST-Segment Elevation Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Intervention

Yıl 2022, Cilt: 25 Sayı: 1, 23 - 32, 18.04.2022

Doğaç Okşen Mert Sarılar Gürsu Demirci İsmail Haberal Okay Abacı

Öz

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.

Anahtar Kelimeler

Angioplasty, myocardial infarction, reperfusion, myocardial revascularization, in hospital mortality

Kaynakça

• 1. Townsend N, Wilson L, Bhatnagar P, Wickramasinghe K, Rayner M, Nichols M. Cardiovascular disease in Europe: epidemiological update 2016. Eur Heart J 2016;37:3232-45. [Crossref]
• 2. Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, et al. 2017 ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The task force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J 2018;39:119-77. [Crossref]
• 3. Pedersen F, Butrymovich V, Kelbæk H, Wachtell K, Helqvist S, Kastrup J, et al. Short- and long-term cause of death in patients treated with primary PCI for STEMI. J Am Coll Cardiol 2014;64:2101-8. [Crossref]
• 4. Fokkema ML, James SK, Albertsson P, Akerblom A, Calais F, Eriksson P, et al. Population trends in percutaneous coronary intervention: 20-year results from the SCAAR (Swedish Coronary Angiography and Angioplasty Registry). J Am Coll Cardiol 2013;61:1222-30. [Crossref]
• 5. Jernberg T, Johanson P, Held C, Svennblad B, Lindbäck J, Wallentin L, et al. Association between adoption of evidence-based treatment and survival for patients with ST-elevation myocardial infarction. JAMA 2011;305:1677-84. [Crossref]
• 6. Sulo G, Vollset SE, Nygård O, Igland J, Egeland GM, Ebbing, et al. Trends in acute myocardial infarction event rates and risk of recurrences after an incident event in Norway 1994 to 2009 (from a Cardiovascular Disease in Norway Project). Am J Cardiol 2014;113:1777-81. [Crossref]
• 7. Freisinger E, Fuerstenberg T, Malyar NM, Wellmann J, Keil U, Breithardt G, et al. German nationwide data on current trends and management of acute myocardial infarction: discrepancies between trials and real-life. Eur Heart J 2014;35:979-88. [Crossref]
• 8. Smolina K, Wright FL, Rayner M, Goldacre MJ. Incidence and 30-day case fatality for acute myocardial infarction in England in 2010: national-linked database study. Eur J Public Health 2012;22:848-53. [Crossref]
• 9. Enar R. Acute Myocardial Infarction Thrombocardiology (Turkish). 2nd ed. İstanbul: Nobel Tıp Kitabevi, 2004.
• 10. Erol MK, Kayıkçıoğlu M, Kılıçkap M. Rationale and design of the Turkish acute myocardial infarction registry: The TURKMI Study. Anatol J Cardiol 2020;23:169-75. [Crossref]
• 11. Cockcroft DW, Gault MH. Prediction of creatinine clearance from serum creatinine. Nephron 1976;16:31-41. [Crossref]
• 12. Mehran R, Rao SV, Bhatt DL, Gibson CM, Caixeta A, Eikelboom J, et al. Standardized bleeding definitions for cardiovascular clinical trials: a consensus report from the Bleeding Academic Research Consortium. Circulation 2011;123:2736-47. [Crossref]
• 13. Tepel M, Aspelin P, Lameire N. Contrast-induced nephropathy: a clinical and evidence-based approach. Circulation 2001;113:1799-806. [Crossref]
• 14. Taniwaki M, Stefanini GG, Räber L, Brugaletta S, Cequier A, Heg D, et al. Predictors of adverse events among patients undergoing primary percutaneous coronary intervention: insights from a pooled analysis of the COMFORTABLE AMI and EXAMINATION trials. Euro Intervention 2015;11:391-8. [Crossref]
• 15. Liosis S, Hochadel M, Darius H, Behrens S, Mudra H, Lauer B, et al. Effect of renal insufficiency and diabetes mellitus on in-hospital mortality after acute coronary syndromes treated with primary PCI. Results from the ALKK PCI Registry. Int J Cardiol 2019;292:43-9. [Crossref]
• 16. Zorbozan O, Cevik AA, Acar N, Ozakin E, Ozcelik H, Birdane A, et al. Predictors of mortality in ST-elevation MI patients: A prospective study. Medicine (Baltimore). 2018;97:e0065. [Crossref]
• 17. Siudak Z, Birkemeyer R, Dziewierz A, Rakowski T, Zmudka K, Dubiel JS, et al. Out-of-hospital cardiac arrest in patients treated with primary PCI for STEMI. Long-term follow up data from EUROTRANSFER registry. Resuscitation 2012;83:303-6. [Crossref]
• 18. Medi C, Montalescot G, Budaj A, Fox KA, López-Sendón J, FitzGerald G, et al. Reperfusion in patients with renal dysfunction after presentation with ST-segment elevation or left bundle branch block: GRACE (Global Registry of Acute Coronary Events). JACC Cardiovasc Interv 2009;2:26-33.
 [Crossref]
• 19. Caspi O, Habib M, Cohen Y, Kerner A, Roguin A, Abergel E, et al. Acute kidney injury after primary angioplasty: Is contrast-induced nephropathy the culprit J Am Heart Assoc 2017;6:e005715. [Crossref]
• 20. Narula A, Mehran R, Weisz G, Dangas GD, Yu J, Généreux P, et al. Contrast-induced acute kidney injury after primary percutaneous coronary intervention: results from the HORIZONS-AMI substudy. Eur Heart J 2014;35:1533-40. [Crossref]
• 21. Sabate M, Cequier A, Iñiguez A, Serra A, Hernandez-Antolin R, Mainar V, et al. Everolimus-eluting stent versus bare-metal stent in ST-segment elevation myocardial infarction (EXAMINATION): 1 year results of a randomised controlled trial. Lancet 2012;380:1482-90.
 [Crossref]
• 22. Sabaté M, Brugaletta S, Cequier A, Iñiguez A, Serra A, Jiménez-Quevedo P, et al. Clinical outcomes in patients with ST-segment elevation myocardial infarction treated with everolimus-eluting stents versus bare-metal stents (EXAMINATION): 5-year results of a randomised trial. Lancet 2016;387:357-66. [Crossref]
• 23. Burzotta F, De Vita M, Gu YL, Isshiki T, Lefèvre T, Kaltoft A, et al. Clinical impact of thrombectomy in acute ST-elevation myocardial infarction: an individual patient-data pooled analysis of 11 trials. Eur Heart J 2009;30:2193-203. [Crossref]
• 24. Fröbert O, Lagerqvist B, Olivecrona GK, Omerovic E, Gudnason T, Maeng M, et al. Thrombus aspiration during ST-segment elevation myocardial infarction. N Engl J Med 2013;369:1587-97.
 [Crossref]
• 25. Jolly SS, Cairns JA, Yusuf S, Meeks B, Pogue J, Rokoss MJ, et al. Randomized trial of primary PCI with or without routine manual thrombectomy. N Engl J Med 2015;372:1389-98. [Crossref]
• 26. Gunasekara AP, Walters DL, Aroney CN. Comparison of abciximab with “high-dose” tirofiban in patients undergoing percutaneous coronary intervention. Int J Cardiol 2006;109:16-20.
 [Crossref]
• 27. Kaymaz C, Keleş N, Özdemir N, Tanboğa İH, Demircan HC, Can MM, et al. The effects of tirofiban infusion on clinical and angiographic outcomes of patients with STEMI undergoing primary PCI. Anatol J Cardiol 2015;15:899-906. [Crossref]
• 28. Welsh RC, Sidhu RS, Cairns JA, Lavi S, Kedev S, Moreno R, et al. Outcomes among clopidogrel, prasugrel, and ticagrelor in st-elevation myocardial infarction patients who underwent primary percutaneous coronary intervention from the TOTAL trial. Can J Cardiol 2019;35:1377-85.
 [Crossref]
• 29. Rafique AM, Nayyar P, Wang TY, Mehran R, Baber U, Berger PB, et al. Optimal P2Y12 inhibitor in patients with st-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention: a network meta-analysis. JACC Cardiovasc Interv 2016;9:1036-46.
 [Crossref]