[Primary percutaneous coronary interventions in acute myocardial infraction with ST-segment elevation. Experience in
Dariusz Dudek1, Tomasz Rakowski, Krzysztof Zmudka
1II Klinika Kardiologii Instytutu Kardiologii, Collegium Medicum, Uniwersytetu Jagiellońskiego w Krakowie. mcdudek@cyf-kr.edu.pl
Insights
Primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction is safe without on-site surgical backup. This approach is feasible with stents, GP IIb/IIIa inhibitors, and rapid transfer to cardiac surgery.
Area of Science:
- Cardiology
- Interventional Cardiology
Context:
- Primary percutaneous coronary intervention (PCI) is the preferred treatment for ST-segment elevation myocardial infarction (STEMI).
- The safety of primary PCI in facilities without on-site surgical backup requires evaluation.
- Coronary stents and GP IIb/IIIa inhibitors have improved PCI outcomes.
Purpose:
- To assess the safety and clinical outcomes of primary PCI for STEMI performed in a catheterization laboratory without on-site surgical backup.
- To evaluate short- and long-term outcomes in patients transferred promptly to a cardiac surgery department.
Summary:
- A cohort of 249 patients underwent primary PCI with a transfer time of <30 minutes to surgical backup.
- Stents were used in 43%, GP IIb/IIIa inhibitors in 54.2%. In-hospital mortality was 6%.
- Six-month follow-up showed a 2.4% mortality and 2.8% myocardial infarction rate, with 84% event-free survival.
Impact:
- Primary PCI is feasible and safe in centers without immediate surgical facilities, provided specific adjuncts and rapid transfer protocols are in place.
- This study supports the expansion of primary PCI services to a wider range of hospitals.
- Optimized logistics and adjunct use can mitigate risks associated with remote surgical backup.
Background:
Primary percutaneous coronary intervention (PCI) in patients (pts) with ST-segment elevation myocardial infarction is regarded as treatment superior to thrombolysis. Coronary stents and GP IIb/IIIa receptor inhibitors improved safety and clinical outcome of interventional procedures. Safety of primary PCI procedure in catheterisation laboratories which do not have on-site surgical backup is still under evaluation.
Methods:
In a cohort of 249 consecutive patients we analysed short and long-term clinical outcome of primary PCI performed in catheterisation laboratory which is located several kilometres from a cardiac surgery department, with an effective transfer time < 30 minutes.
Results:
Coronary stents were implanted in 43% pts. GP IIb/IIIa receptor inhibitors were used in 54.2% pts. Cardiogenic shock on admission was diagnosed in 7.2% pts. Intra-aortic balloon counterpulsation usage was necessary in 6.4% pts. In-hospital mortality was 6% (3.5% in non-shock pts). In two pts (0.8%) during hospitalization repeat PCI was performed--in one case due to reinfarction. No urgent cardiosurgery intervention was necessary. Mortality and myocardial infarction rate after hospital discharge during 6 month follow up was 2.4% and 2.8% respectively. In 4% pts repeated PCI was performed due to restensosis. Cumulative event free survival was 84%.
Conclusion:
Primary PCI procedure for acute myocardial infarction seems to be feasible and safe in catheterisation laboratories without on-site surgical backup provided usage of stents, GPIIb/IIIa receptor inhibitors and intraaortic balloon counterpulsation and cooperation with a nearby cardiosurgery department with short transfer time.
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