Impact of primary PCI volume on hospital mortality in STEMI patients: Does time-to-presentation matter?

Eliano Pio Navarese, Stefano De Servi, Alessandro Politi, Alessandro Martinoni, Giuseppe Musumeci, Enrico Boschetti, Guido Belli, Maurizio D'Urbano, Emanuela Piccaluga, Corrado Lettieri, Silvio Klugmann

Research output: Contribution to journalArticlepeer-review

Abstract

The exact relationship between primary percutaneous coronary intervention (PCI) volume and mortality remains unclear. No data are available on how this relationship could be affected by time-to-presentation. The primary aim of this study was to evaluate the impact of hospital primary PCI volume on in-hospital mortality in ST-elevation myocardial infarction (STEMI) patients depending on time-to-presentation. The impact of primary PCI volume on in-hospital mortality was investigated in a prospective registry of the Lombardy region in Northern Italy, deriving data on mortality rates and number of primary PCIs from a cohort of 2,558 patients. We also explored this relationship at different times-to-presentation (≤90 min,>90 min-180 min,>180 min) and risk profiles assessed with the TIMI Risk Index. A strong inverse relationship was found between primary PCI hospital volume and risk-adjusted mortality (r = -0.9; P66 primary PCIs/year (OR = 0.21 [95% CI 0.10-0.47], P90 min-180 min, the model was less significant (P = 0.02) with a higher threshold of procedures (>145 primary PCIs/year) required to provide benefits. The model was not predictive of survival for time-to- presentation>180 min (P = 0.30). The reduction of mortality of STEMI patients treated at high-volume primary PCI centers is time-dependent and affected by risk profile. The greatest benefit was observed in high-risk patients presenting within 90 min from symptoms onset.

Original languageEnglish
Pages (from-to)223-231
Number of pages9
JournalJournal of Thrombosis and Thrombolysis
Volume32
Issue number2
DOIs
Publication statusPublished - Aug 2011

Keywords

  • Mortality
  • Primary PCI
  • Risk profile
  • ST-elevation myocardial infarction

ASJC Scopus subject areas

  • Hematology
  • Cardiology and Cardiovascular Medicine

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