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Published on: September 22, 2020
LombardIMA: a regional registry for coronary angioplasty in ST-elevation myocardial infarction
Alessandro Politi1, Alessandro Martinoni, Silvio Klugmann
1Cardiology Department, Ospedale Moriggia Pelascini, Italia Hospital, Gravedona, Italy. politiarea@tiscali.it
Insights
This registry study of ST-elevation myocardial infarction (STEMI) patients undergoing percutaneous coronary intervention (PCI) in Lombardy provides real-world outcomes. It highlights predictors of mortality, offering benchmarks for future STEMI care.
Area of Science:
- Cardiology
- Interventional Cardiology
- Public Health
Background:
- Percutaneous coronary intervention (PCI) is optimal reperfusion therapy for ST-elevation myocardial infarction (STEMI).
- Real-world registry data reveal disparities compared to randomized trials in STEMI patient populations and outcomes.
Purpose of the Study:
- To assess the current status of STEMI treatment using a registry in Lombardy, Italy.
- To establish a benchmark for STEMI care in a densely populated region with established treatment networks.
Main Methods:
- The LombardIMA PCI registry enrolled 3901 STEMI patients undergoing PCI within 12 hours of symptom onset.
- Data collected from 32 hub centers included primary PCI, facilitated PCI, and rescue PCI procedures.
- Multivariate analysis identified predictors of 30-day mortality.
Main Results:
- In-hospital and 30-day mortality rates were 4.4% and 6.6%, respectively.
- Negative predictors of mortality included Killip class 3-4, multiple ECG leads, renal failure, and age.
- Positive predictors included ST resolution >50% and Thrombolysis In Myocardial Infarction (TIMI) flow grade 3.
Conclusions:
- The LombardIMA PCI registry reflects real-world STEMI patient care with PCI.
- Findings can serve as a benchmark for other Italian regions and inform future STEMI management strategies.
Background:
Percutaneous coronary intervention (PCI) has been shown to be the best reperfusion therapy for acute myocardial infarction with ST-elevation (STEMI), but data from registries show differences in patient populations and outcomes between randomized trials and real life.
Objectives:
We sought to provide information about the current status of this treatment with a registry collecting data in Lombardy, the most densely populated region in Italy, with widespread availability of cathlabs and a well-established network for the treatment of STEMI.
Methods And Results:
Patient enrollment was performed by 32 hub centres recruiting 3901 STEMI patients who underwent PCI procedures within 12 h of the onset of symptoms, of whom 3317 patients underwent primary PCI, 376 'facilitated' PCI, and 208 rescue PCI in cathlabs located, in 77% of cases, in the same hospital of admission. In-hospital and 30-day total death were 4.4 and 6.6%, respectively. At multivariate analysis independent negative predictors of 30-day mortality were Killip class 3-4, number of involved ECG leads, chronic renal failure and age, whereas positive predictors were ST resolution more than 50% and postprocedural grade 3 thrombolysis in myocardial infarction flow.
Conclusions:
LombardIMA PCI registry enrolled STEMI patients representing a real-world population treated with PCI. Findings presented in this study may provide a benchmark for similar registries undertaken in other Italian regions and may be helpful to assess future possible developments of care for STEMI patients.
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