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Myocardial Infarction and Functional Outcome Assessment in Pigs
Published on: April 25, 2014
Long-term survival and functional outcome of unselected patients undergoing percutaneous coronary intervention for
Pablo Anabitarte1, David J Kurz, Irene Stettler
1Division of Cardiology, Department of Internal Medicine, Triemli Hospital, Zurich, Switzerland. pablo.anabitarte@ksa.ch
Insights
Long-term survival after percutaneous coronary intervention (PCI) for acute myocardial infarction (MI) shows a stable 2% annual mortality. Most survivors achieve good functional capacity, with predictors differing for in-hospital versus post-discharge outcomes.
Area of Science:
- Cardiology
- Interventional Cardiology
- Acute Myocardial Infarction Management
Background:
- Percutaneous coronary intervention (PCI) is a primary reperfusion therapy for acute myocardial infarction (MI).
- Limited data exist on long-term survival and functional outcomes following emergency PCI for MI.
Purpose of the Study:
- To analyze long-term survival and functional capacity in patients undergoing emergency PCI for acute MI.
- To identify predictors of in-hospital mortality, post-discharge mortality, and late functional capacity.
Main Methods:
- Systematic analysis of 1000 consecutive patients treated with emergency PCI in a single-center registry.
- Multivariate analysis to determine predictors of mortality and functional outcomes.
- Median follow-up of 3.2 years for 978 patients.
Main Results:
- In-hospital and post-discharge mortality rates were 7.6% and 7.3%, respectively.
- Annualized post-discharge mortality remained stable at 2% per year.
- 47% of patients had normal functional capacity, and 49.1% were in NYHA functional class II at late follow-up.
Conclusions:
- Post-discharge mortality after PCI for acute MI is approximately 2% annually.
- Predictors for in-hospital and post-discharge mortality differ significantly.
- Good functional capacity is achievable long-term, even for patients initially presenting with cardiogenic shock.
Background:
Percutaneous coronary intervention (PCI) is the most effective reperfusion modality in patients with acute myocardial infarction (MI). Data concerning long-term survival and functional outcome are sparse.
Methods:
One thousand consecutive patients treated by emergency PCI were systematically ana-lysed in a single-centre registry. Multivariate predictors of in-hospital mortality, post-discharge mortality and late functional capacity were identified.
Results:
Follow-up was completed for 978 patients. The median clinical follow-up length was 3.2 years. In-hospital and post-discharge mortality were 7.6% and 7.3%, respectively. Annualised post-discharge mortality remained stable over time at 2% per year. Independent predictors of in-hospital death were cardiogenic shock, TIMI flow <3 after PCI, left ventricular ejection fraction <40%, age and time to patent artery >6 h. Independent predictors of post-discharge mortality were TIMI flow after PCI <3, prior MI, elevated glucose levels at admission, and increasing age. In contrast, cardiogenic shock, time to patent artery and left ventricular ejection fraction <40% were not independently associated with post-hospital death. At late follow-up, 47% of patients had normal functional capacity and 49.1% were in New York Heart Association functional class II. Predictors of impaired functional capacity at follow-up were age, gender, smoking habits and multivessel coronary disease.
Conclusions:
Post-discharge mortality after PCI for acute MI was 2% per year. Significant differences exist between predictors of in-hospital and post-discharge mortality. The functional capacity of surviving patients was remarkably good, even when presented in cardiogenic shock.
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