Five year outcome after primary coronary intervention for acute ST elevation myocardial infarction: results from a
G Parodi1, G Memisha, R Valenti
1Division of Cardiology, Careggi Hospital, Florence, Italy. parodiguido@libero.it
Insights
Primary percutaneous coronary intervention (PCI) for ST elevation acute myocardial infarction (AMI) shows sustained positive outcomes over five years. Key risk factors for mortality include age, cardiogenic shock, prior heart attack, and multivessel disease.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Outcomes Research
Background:
- Acute myocardial infarction (AMI) remains a leading cause of mortality worldwide.
- Primary percutaneous coronary intervention (PCI) has become a standard treatment for ST-elevation AMI (STEMI).
- Long-term outcomes following primary PCI for STEMI require continued evaluation.
Purpose of the Study:
- To analyze the five-year clinical outcomes of unselected patients with STEMI treated with primary PCI.
- To identify predictors of long-term mortality after primary PCI for STEMI.
Main Methods:
- Retrospective analysis of 1009 consecutive STEMI patients undergoing primary PCI at a high-volume PCI tertiary center.
- Clinical follow-up data collected for a mean of 51 months (97.8% follow-up rate).
- Multivariate Cox proportional hazards analysis used to identify mortality predictors.
Main Results:
- Overall five-year mortality was 20%, with cardiac mortality at 16%.
- Non-fatal reinfarction occurred in 5% of patients, and 19% required additional revascularization.
- Independent predictors of mortality included older age, cardiogenic shock, previous myocardial infarction, and multivessel coronary artery disease.
Conclusions:
- Routine primary PCI for STEMI demonstrates sustained favorable outcomes over several years.
- Simple clinical and angiographic factors can identify patients at high risk for long-term mortality.
- The risk of death increases progressively with the number of identified high-risk features.
Objectives:
To analyse the five year outcome of unselected patients with acute myocardial infarction (AMI) treated by primary percutaneous coronary intervention (PCI).
Setting:
High volume PCI tertiary centre.
Design And Results:
The study was based on a sample of 1009 consecutive patients with ST elevation AMI treated by primary PCI. The mean (SD) clinical follow up was 51 (21) months and the follow up rate was 97.8%. The overall mortality was 20% and cardiac mortality was 16%. Non-fatal reinfarction rate was 5% and additional revascularisation procedure rate was 19%. Hospitalisation for heart failure was needed by 42 patients (4%). The variables related to mortality in multivariate Cox analysis were age (hazard ratio (HR) 1.054, 95% confidence interval (CI) 1.039 to 1.069, p < 0.0001), cardiogenic shock (HR 2.985, 95% CI 2.157 to 4.129, p < 0.0001), previous myocardial infarction (HR 1.696, 95% CI 1.199 to 2.398, p = 0.0003), and the presence of multivessel coronary artery disease (HR 1.820, 95% CI 1.317 to 2.514, p = 0.0003). Each additional high risk feature was associated with a relative risk for five year death of 2.328 (95% CI 2.048 to 2.646, p < 0.0001).
Conclusions:
The satisfactory results of routine mechanical revascularisation strategy in AMI were maintained during several years of follow up. Patients at risk of death during long term follow up may be identified by simple clinical and angiographic characteristics, such as old age, cardiogenic shock, previous myocardial infarction, and multivessel coronary artery disease. The risk of death progressively increases with the number of these high risk features.
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