Emergency percutaneous coronary interventions for acute myocardial infarction with ST-segment elevation in a regional
Christophe Sierro1, Alexandre Berger, Eric Eeckhout
1Unit of Cardiology, Regional Hospital (CHCV), Sion, Switzerland. Christophe.Sierro@chuv.ch
Insights
Primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) is safe in regional hospitals. Adherence to international guidelines ensures comparable outcomes to university centers for STEMI patients receiving emergency angioplasty.
Area of Science:
- Cardiology
- Interventional Cardiology
- Acute Myocardial Infarction Management
Background:
- Primary percutaneous coronary intervention (PCI) is the leading revascularization strategy for ST-segment elevation myocardial infarction (STEMI).
- Tertiary hospitals provide 24/7 PCI, but its feasibility in regional centers is less understood.
- This study compares short-term outcomes of primary PCI for STEMI in a regional versus a university hospital.
Purpose of the Study:
- To evaluate the safety and efficacy of primary PCI for STEMI in a regional hospital.
- To compare short-term outcomes of STEMI patients treated with primary PCI in a regional institution versus a university hospital.
- To determine if a regional hospital can achieve outcomes comparable to a university hospital when performing emergency angioplasty.
Main Methods:
- Retrospective analysis of consecutive STEMI patients undergoing emergency coronary arteriography from January to December 2002.
- Inclusion of patients from a regional hospital (CHCV, Sion) and a university hospital (CHUV, Lausanne).
- Primary endpoint: combined incidence of in-hospital death, reinfarction, and target vessel revascularization (TVR) at 7 days.
Main Results:
- The study included 58 patients at CHCV and 160 at CHUV, with similar baseline characteristics except for a higher smoking rate in CHCV.
- Both centers predominantly used PCI (80% CHCV, 86% CHUV) with low rates of urgent surgical treatment.
- No statistically significant difference in 7-day adverse event-free survival was observed between the two centers.
Conclusions:
- The CHCV meets international guidelines for emergency angioplasty, enabling safe primary PCI for STEMI.
- Around-the-clock primary PCI can be safely performed in regional hospitals like CHCV Sion.
- Strict adherence to international guidelines is crucial for achieving comparable outcomes in regional settings.
Background:
An invasive approach of acute myocardial infarction with ST-segment elevation (STEMI) with primary percutaneous coronary intervention (PCI) is currently considered as the most efficient revascularisation strategy and is performed around-the-clock in tertiary hospitals. The present study is aimed at investigating the short term outcome of primary PCI eligible patients after STEMI in a regional institution (CHCV, Sion) in comparison to a University Hospital (CHUV, Lausanne).
Methods:
From January the 1st to December the 31st 2002, all consecutive STEMI patients of both centres who had an emergency coronary arteriography were included in the analysis. Clinical and angiographic data were retrospectively collected. The primary end point was the combined incidence of in-hospital death, reinfarction, and target vessel revascularisation (TVR) at 7 days.
Results:
The analysis included 58 patients in the CHVC (60+/-13 years, 16% of whom were female) and 160 patients in the CHUV (63+/-12 years, 25% were female). Both populations were identical according to the severity of coronary artery disease and distribution of risk factors, except for smokers (55% in CHCV, 39% CHUV, p=0.04). Most of the patients were treated by PCI in both centres (80% CHCV versus 86% CHUV, p=NS). A low proportion in both groups underwent urgent surgical treatment (3.5% CHCV versus 5.5% CHUV, p=NS). At 7 days, adverse events free survival was not statistically different.
Conclusion:
These results were expected because the CHCV fulfils the international guidelines criteria for performance of emergency angioplasty. Our study demonstrates that around-the-clock primary PCI for acute STEMI can safely be done in a regional hospital (CHCV Sion) providing there is strict adherence to all aspects of international guidelines.
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