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Published on: May 28, 2019
Long-term prognosis after primary PCI in unselected patients with ST-elevation myocardial infarction
Alessandro Barchielli1, Giovanni M Santoro, Daniela Balzi
1Epidemiology Unit, Local Health Unit 10-Firenze, Florence, Italy. alessandro.barchielli@asf.toscana.it
Insights
Primary percutaneous coronary intervention (pPCI) significantly improves long-term survival for ST-segment elevation myocardial infarction (STEMI) patients. This benefit persists even in older individuals, highlighting the importance of timely pPCI for all STEMI cases.
Area of Science:
- Cardiology
- Interventional Cardiology
- Public Health
Background:
- Long-term prognosis after ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (pPCI) is not well-established in unselected populations.
- The Florence Acute Myocardial Infarction Registry provides a valuable dataset for investigating long-term outcomes.
Purpose of the Study:
- To analyze the 8-year prognosis of STEMI patients treated with pPCI versus conservative management.
- To assess the long-term impact of pPCI on mortality and major adverse cardiac events.
Main Methods:
- An observational study of 875 STEMI patients from the Florence Acute Myocardial Infarction Registry (2000-2001).
- Multivariable Cox regression analysis was used to evaluate the prognostic effect of pPCI, adjusting for clinical and demographic factors.
- Outcomes included a composite endpoint (new myocardial infarction, urgent revascularization, or death) and all-cause mortality.
Main Results:
- After 8 years, 59% experienced the composite endpoint and 49% died.
- pPCI was associated with a significantly better prognosis (HR 0.72, P=0.001), maintained even in patients event-free after one year (HR 0.72, P=0.010).
- Benefits of pPCI were observed across all age groups, including those over 75 years, and persisted when analyzing all-cause mortality alone.
Conclusions:
- Primary percutaneous coronary intervention offers a sustained survival advantage for STEMI patients up to 8 years post-event.
- The long-term benefits of pPCI are evident even in elderly STEMI patients, underscoring the need for equitable access to this treatment.
- Improving the delivery of care for older STEMI patients is crucial to maximize the benefits of pPCI.
Aims:
Long-term prognosis of ST segment elevation myocardial infarction (STEMI) in the era of primary percutaneous coronary intervention (pPCI) remains relatively poorly investigated in unselected patients. This study analyzed 8-year follow-up of STEMI patients enrolled in the Florence Acute Myocardial Infarction Registry, a population-based, observational study performed in Italy in 2000-2001.
Methods:
The prognostic effect of pPCI adjusted for clinical and demographic characteristics on a composite end-point of new myocardial infraction, urgent revascularization or death, and on all-cause mortality separately, was assessed in multivariable Cox analysis, calculating hazard ratios and 95% confidence intervals. This analysis is concerned with 875 STEMI patients (mean age 70.6 ± 12.9 years), treated with pPCI (459) or conservatively (416).
Results:
After 8 years, 59% of patients had experienced the composite end-point and 49% had died. The multivariable analysis showed a significantly better prognosis in patients receiving pPCI (hazard ratio 0.72, P = 0.001), evident also in the 645 patients who were event-free after the first year of follow-up (hazard ratio 0.72, P = 0.010). Other independent prognostic factors were advanced age, Killip class greater than 1, some cardiovascular or noncardiovascular comorbidities, in-hospital cardiogenic shock, ejection fraction less than 30%, and treatment with aspirin and statin during hospitalization. The beneficial effect of pPCI observed both in cases younger (adjusted hazard ratio 0.65, P = 0.013) and older than 75 years (adjusted hazard ratio 0.65, P = 0.001) was also confirmed considering as outcome all-cause mortality only.
Conclusions:
In unselected STEMI patients, survival advantage from pPCI extends for a long term (8 years). This survival advantage is maintained at advanced ages, thus enforcing the importance of improving delivery of appropriate care to older STEMI patients.
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