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[Primary angioplasty in acute coronary syndromes with ST-segment elevation: experience of three Alsacian centers]
M Hanssen1, Y Gottwalles, J P Monassier
1Centre Hospitalier, Fédération de cardiologie, Haguenau.
Insights
Primary angioplasty is a coherent strategy for ST-elevation acute coronary syndromes, showing low complication and mortality rates. However, high-risk patients, including those with cardiogenic shock or advanced age, face poorer outcomes.
Area of Science:
- Cardiology
- Interventional Cardiology
- Acute Coronary Syndromes
Context:
- European Society of Cardiology guidelines recommend primary angioplasty for ST-elevation acute coronary syndromes within 90 minutes of first medical contact.
- A prospective registry of 2504 patients across three Alsacian centers (1999-2004) evaluated the real-world application of this strategy.
- The study included a significant proportion of high-risk patients, such as those aged over 70, Killip grade 3 or higher, resuscitated sudden death survivors, and those in cardiogenic shock.
Purpose:
- To assess the feasibility, efficacy, and safety of primary angioplasty as a treatment for ST-elevation acute coronary syndromes in a real-world setting.
- To evaluate procedural success rates, in-hospital mortality, and complication rates, particularly in high-risk patient subsets.
- To determine if the systematic policy of primary angioplasty aligns with clinical outcomes and guidelines.
Summary:
- The average door-to-reperfusion time was 79 minutes, with an immediate procedural success rate (TIMI 3 flow) of 96.5%.
- Overall in-hospital mortality was 9.3%, but significantly higher in patients with combinations of resuscitated sudden death/cardiogenic shock (69%) or age ≥75/cardiogenic shock (72.6%).
- The bleeding complication rate was low at 1.4%, supporting the coherence of systematic primary angioplasty, except for specific high-risk groups.
Impact:
- Demonstrates that systematic primary angioplasty is a viable and effective strategy for ST-elevation acute coronary syndromes, achieving guideline-recommended timelines in a real-world setting.
- Highlights the critical importance of identifying and managing high-risk patient profiles, as they experience substantially worse outcomes despite timely intervention.
- Provides evidence supporting the continued use and refinement of primary angioplasty protocols, emphasizing the need for specialized care pathways for high-risk individuals.
Abstract:
The guidelines of the European Society of Cardiology, published in 2003, consider primary angioplasty as the preferred treatment strategy in acute coronary syndromes with ST-segment elevation, if the procedure can be performed within 90 min after first medical contact. We report the experience of three Alsacian centers running a common prospective registry with 2504 consecutive patients enroled between January 1999 and December 2004. The average age of the patients was 62 years with a proportion of 24% women. The time delay "pain to admission" was > or =3 hours in 55.9% of the cases. The treatment delay "door to catheterisation needle" was 59 min and the mean delay "door-to-reperfusion" was 79 min. The study population was representative of the real world including subsets of patients with a particulary high risk profile: age > or =70 years in 33%, a Killip grade > or =3 in 11.5%, rescucitated sudden death in 6.6% and cardiogenic shock in 10.9% of the patients respectively. The immediate procedural success rate (Timi 3 flow) in the treated coronary artery was 96.5%. The overall inhospital mortality-rate was 9.3%. The combinations of rescucitated sudden death--cardiogenic shock or age > or =75 years--cardiogenic shock were associated with a poor clinical outcome and mortality rates of 69% and 72.6% respectively, where as in the absence of abovementioned clinical high risk settings, the mortality rate was as low as 1.4%. The overall bleeding complication rate was 1.4%. The policy of systematic primary angioplasty in acute coronary syndromes with ST-Segment elevation appears to be coherent. The procedural complications and the in-hospital mortality rates were low, except in the presence of above mentioned clinical high risk settings.
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