AimTo determine the relationship between plasminogen activator inhibitor-1 (PAI-1) activity rise during the first 24 hours of ST-elevation myocardial infarction (STEMI) treatment and death after 5 years.MethodsFrom May 1, 2009 to March 23, 2010, 87 STEMI patients treated with primary percutaneous coronary intervention (PCI) at the Sestre Milosrdnice University Hospital Center were consecutively enrolled in prospective single-center cohort study. PAI-1 activity was determined on admission and 24 hours later. The primary end-point was death after 5 years. The predictive value of PAI-1 activity variables as biomarkers of death was assessed using receiver operating characteristic (ROC) curve, independent predictors of death were assessed using multivariate Cox regression, and covariates independently related to higher PAI-1 activity rise were assessed using linear regression.ResultsTwo patients died during the hospital treatment and 11 during the follow-up. PAI-1 activity rise had the largest area under curve (0.748) for predicting death rate (optimal cut-off point 3.7 U/mL, sensitivity 53.8%, specificity 90.5%). Patients with PAI-1 activity rise higher than 3.7 U/mL had significantly higher mortality (P < 0.001). Kaplan-Meier survival curve diverged within the first year after STEMI. Independent predictors of death were PAI-1 rise and final TIMI flow. PAI-1 activity rise was independently related to heart failure, thrombus aspiration, and body weight.ConclusionPAI-1 activity rise higher than 3.7 U/mL is associated with higher 5-year death rate in STEMI patients treated with primary PCI.Oxford Centre for Evidence-based Medicine level of evidence: 3.
In the last few years University Hospital Center Sestre milosrdnice, Zagreb has become dedicated to the radial approach with nearby 90% of percutaneous coronary interventions (PCI) performed with either left or right radial access route. In time, left radial approach has become the first choice option for most of the patients (pts) with acute ST-segment elevation myocardial infarction (STEMI). The aim of this study was to compare the efficacy and safety of left transradial access (L-TRA) with the right transradial (R-TRA) and transfemoral (TFA) access in the setting of primary (PCI) for acute (STEMI). Patients and Methods: This single-center, retrospective study included 767 consecutive acute STEMI patients, treated with primary PCI from January 2011 to May 2013, who were divided in three groups according to the arterial access site: L-TRA group (413 patients, 53.85%), R-TRA group (110 patients, 14.34%) and TFA group (244 patients, 31.81%). We collected data on the procedure success, procedure, door-to-balloon and fluoroscopy time and bleeding complications. Of all the patients, 43.5% of them were ad-
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