Long-term prognosis after primary PCI in unselected patients with ST-elevation myocardial infarction

Alessandro Barchielli, Giovanni M. Santoro, Daniela Balzi, Nazario Carrabba, Mauro Di Bari, Gian Franco Gensini, Maurizio Filice, Cristina M. Landini, Serafina Valente, Alfredo Zuppiroli, Niccolò Marchionni

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish
Pages (from-to)819-827
Number of pages9
JournalJournal of Cardiovascular Medicine
Volume13
Issue number12
DOIs
Publication statusPublished - Dec 2012

Keywords

  • community registry
  • primary coronary intervention
  • prognosis
  • ST-elevation myocardial infarction

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Fingerprint Dive into the research topics of 'Long-term prognosis after primary PCI in unselected patients with ST-elevation myocardial infarction'. Together they form a unique fingerprint.

Cite this