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Published on: January 28, 2020
Predictors of long-term outcomes following direct percutaneous coronary intervention for acute myocardial infarction
N Beohar1, C J Davidson, G Weigold
1Department of Medicine, Division of Cardiology, Northwestern University Medical School, Chicago, Illinois, USA.
Insights
Direct percutaneous coronary intervention (PCI) effectively treats ST-segment elevation acute myocardial infarction (AMI). Long-term outcomes depend on initial cardiac impairment and narrowed arteries, with abciximab improving major adverse cardiac events.
Area of Science:
- Cardiology
- Interventional Cardiology
Background:
- ST-segment elevation acute myocardial infarction (AMI) requires timely intervention.
- Direct percutaneous coronary intervention (PCI) is a primary treatment strategy.
- Predictors of long-term outcomes after direct PCI for AMI are not fully elucidated.
Purpose of the Study:
- To identify predictors of long-term major adverse cardiac events (MACE) in unselected patients with AMI treated with direct PCI.
- To evaluate the long-term efficacy and safety of direct PCI in AMI patients.
Main Methods:
- Prospective evaluation of 274 consecutive patients presenting within 12 hours of AMI.
- Direct PCI performed in 227 patients; no intravenous thrombolysis used.
- Long-term follow-up (median 20 months) for MACE, including death, recurrent AMI, repeat PCI, CABG, and stroke.
Main Results:
- Successful PCI in 95% of patients; in-hospital MACE rate of 5.3% for direct PCI group.
- Post-discharge MACE at long-term follow-up: 10% died, 3.5% had recurrent AMI, 9% repeat PCI, 5% CABG.
- Multivariate predictors of MACE: abciximab use (HR 0.6), Killip class (HR 2.2), and number of narrowed coronary arteries (HR 1.7).
Conclusions:
- Direct PCI demonstrates sustained long-term efficacy in unselected AMI patients.
- Cardiac impairment at presentation and extent of coronary artery disease predict MACE.
- Abciximab use is associated with significantly improved MACE, independent of device selection.
Abstract:
To determine predictors of a long-term major adverse cardiac event (MACE) in unselected patients undergoing direct percutaneous coronary intervention (PCI), 274 consecutive patients presenting within 12 hours of ST-segment elevation acute myocardial infarction (AMI) were evaluated. No patient with ST-segment elevation AMI received intravenous thrombolytic drugs. Chest pain to balloon time was 3.8 hours (range 2.5 to 6.9). percutaneous transluminal coronary angioplasty was successful in 95% of patients. Abciximab was administered to 69% of patients, stents were deployed in 53%, and 17% underwent only catheterization. In-hospital events were death (7%), abrupt closure (2%), emergent coronary artery bypass grafting (CABG) (5%), repeat PCI (3%), and recurrent myocardial infarction (1%). In patients undergoing direct PCI (n = 227), the in-hospital event rate was death 5.3%, abrupt closure 2.2%, emergency CABG 0.9%, repeat PCI 3.1%, and repeat myocardial infarction 1.3%. Median time to last follow-up or death was 20 months (range 11 to 34), and to any event, 0.3 months (range 0.03 to 24.0). Postdischarge MACE included death (5%), AMI (4%), repeat PCI (8%), CABG (9%), and stroke (0.7%). Among those undergoing direct PCI (n = 227), 10% died, 3.5% had a repeat AMI, 9% had a repeat PCI, 5% had CABG, and 1% had a stroke at long-term follow-up. At long-term follow-up, 75% were event free. Multivariate predictors were (hazard ratio [95% confidence interval (CI)]): abciximab use 0.6 (95% CI 0.43 to 0.95), Killip class 2.2 (95% CI 1.1 to 4.4), and number of narrowed coronary arteries 1.7 (95% CI 1.4 to 2.2). In this unselected consecutive series of patients presenting with ST-segment elevation AMI, direct PCI was associated with sustained long-term efficacy. Outcomes were predicted by cardiac impairment at presentation and number of narrowed coronary arteries. MACE is not related to device selection but is significantly improved with abciximab.
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