Strategies to Lower In-Hospital Mortality in STEMI Patients with Primary PCI: Analysing Two Years Data from a High-Volume Interventional Centre

Abstract

Objectives. We aimed to analyse data from our high-volume interventional centre (>1000 primary percutaneous coronary interventions (PCI) per year) searching for predictors of in-hospital mortality in acute myocardial infarction (MI) patients. Moreover, we looked for realistic strategies and interventions for lowering in-hospital mortality under the “5 percent threshold.” Background. Although interventional and medical treatment options are constantly expanding, recent studies reported a residual in-hospital mortality ranging between 5 and 10 percent after primary PCI. Current data sustain that mortality after ST-elevation MI will soon reach a point when cannot be reduced any further. Methods. In this retrospective observational single-centre cohort study, we investigated two-year data from a primary PCI registry including 2035 consecutive patients. Uni- and multivariate analysis were performed to identify independent predictors for in-hospital mortality. Results. All variables correlated with mortality in univariate analysis were introduced in a stepwise multivariate linear regression model. Female gender, hypertension, depressed left ventricular ejection fraction, history of MI, multivessel disease, culprit left main stenosis, and cardiogenic shock proved to be independent predictors of in-hospital mortality. The model was validated for sensitivity and specificity using receiver operating characteristic curve. For our model, variables can predict in-hospital mortality with a specificity of 96.60% and a sensitivity of 84.68% (p<0.0001, AUC = 0.93, 95% CI 0.922–0.944). Conclusions. Our analysis identified a predictive model for in-hospital mortality. The majority of deaths were due to cardiogenic shock. We suggested that in order to lower mortality under 5 percent, focus should be on creating a cardiogenic shock system based on the US experience. A shock hub-centre, together with specific transfer algorithms, mobile interventional teams, ventricular assist devices, and surgical hybrid procedures seem to be the next step toward a better management of ST-elevation MI patients and subsequently lower death rates.

Mortality predictors after percutaneous coronary intervention – a prospective single-center registry study

“…The mortality of resuscitated patients and those with cardiogenic shock is disappointingly high, even in the current era of emergent revascularization in PCI centers with 24/7 availability 7,27,43 . Although there is a continuous effort to reduce this high mortality, including the development of dedicated "regionalized cardiogenic shock systems" 44 , and "fourth level centers" 44 equipped with extracorporeal life support and ventricular assist devices, these measures are mainly unavailable in our country 7 .…”

“…The short-term clinical evolution of patients treated by PCI in Romania is well documented, most of the studies reporting in-hospital-or 30-day mortality as a clinical outcome [3][4][5][6][7][8][9][10][11] . However, contemporary data regarding long term mortality of CAD treated by PCI is mainly lacking in Romania: a few studies evaluated this subject, and only for special PCI indications, such as acute ST-elevation myocardial infarction (STEMI; 1-year follow-up) 12,13 or STEMI complicating left main CAD (1-and 3-year follow-up) 14,15 .…”

Peculiarities and Consequences of Different Angiographic Patterns of STEMI Patients Receiving Coronary Angiography Only: Data from a Large Primary PCI Registry

“…Demographic, clinical, biological, and paraclinical variables of our entire population have been described previously in detail [19].…”

“…Recently, we reported data from the same cohort of primary PCI patients dealing with in-hospital mortality and cardiogenic shock [19]. Our facility is a tertiary centre focused on coronary interventions (∼5000 procedures/year, and 1000 primary PCI/year), which provides a 24-hour primary PCI service to a population of 7,000,000 inhabitants, with a referral area that covers community hospitals from the northeastern part of the country.…”

Comparison of major bleeding in patients with acute coronary syndrome that underwent coronary artery bypass grafting treated with clopidogrel or ticagrelor: a systematic review and meta-analysis

“…In the last two decades, the management of acute coronary syndrome (ACS) has been well defined and periodically updated. Management has developed drastically over this period 1 . Management options are numerous, and they depend on the facilities of the hospital.…”