Clinical predictors for failure of percutaneous coronary intervention in ST-elevation myocardial infarction
Israel M Barbash1, Itsik Ben-Dor, Rebecca Torguson
1Interventional Cardiology, Washington Hospital Center, Washington, DC 20010, USA.
Insights
Percutaneous coronary intervention (PCI) failure in ST-elevation myocardial infarction (STEMI) is uncommon but linked to worse outcomes. Female gender and cardiogenic shock are key predictors of PCI failure, necessitating careful management.
Area of Science:
- Cardiology
- Interventional Cardiology
- Acute Coronary Syndromes
Background:
- Failed percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) is associated with adverse outcomes.
- Recent advancements in PCI techniques have raised questions about the current incidence and predictors of primary PCI failure.
Purpose of the Study:
- To determine the incidence and independent predictors of failed primary PCI in patients with STEMI.
- To compare the clinical outcomes of successful versus failed PCI procedures.
Main Methods:
- A retrospective analysis of a clinical database of patients undergoing primary or rescue PCI between 1993 and 2011.
- Comparison of patient characteristics and outcomes between successful and failed PCI groups, with in-hospital, 30-day, and 1-year follow-up.
Main Results:
- PCI failure occurred in 3.98% of 2900 patients.
- Independent predictors of PCI failure included female gender, cardiogenic shock, previous PCI, and type C lesion.
- Failed PCI was associated with significantly higher in-hospital (18% vs. 4%) and long-term mortality (48% vs. 14%).
Conclusions:
- Primary PCI failure in STEMI is infrequent but significantly increases short- and long-term mortality.
- Female patients presenting with STEMI are at a higher risk for PCI failure and require particular attention.
- Identifying predictors of PCI failure can guide clinical decision-making and improve patient management.
Background:
Failed percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) is associated with adverse outcome. With recent improvements in PCI techniques, the incidence and predictors for failed primary PCI are unclear.
Methods:
A clinical database of consecutive patients who underwent primary or rescue PCI from 1993 to 2011 was used to compare patients with successful versus failed PCI. Clinical follow-up was obtained in-hospital, at 30 days and at 1 year.
Results:
Of 2900 patients fulfilling our inclusion criteria, 111 (3.98%) had failed PCI. Patients who had failed PCI were older (65 vs. 61 years), were more likely to be women (46% vs. 32%), were more likely to have previous peripheral vascular disease (19% vs. 11%), previous PCI (29% vs. 20%), and were more likely to present with cardiogenic shock (25% vs. 11%) (all P < 0.05). Multivariable logistic regression analysis identified female gender (OR 1.54; 95% CI 1.01-2.38), cardiogenic shock (2.07; 1.22-3.49), previous PCI (1.71; 1.08-2.70), and type C lesion (2.47; 1.60-3.82) as independent predictors of PCI failure. The in-hospital (18% vs. 4%) and long-term mortality (48% vs. 14%) were worse in the failed PCI group compared to the successful group (P < 0.05).
Conclusion:
In patients with STEMI, primary PCI failure is uncommon. It is associated with worse short- and long-term clinical outcome compared with a successful procedure. Special care should be taken when PCI is performed in women at higher risk for failure when presenting with STEMI.
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