Background
Primary percutaneous coronary intervention (PPCI) is the preferred therapy for patients
presenting with ST-elevation myocardial infarction (STEMI). We reviewed patients undergoing
PCI for STEMI over a 6-year period to evaluate changes in procedural characteristics
and clinical outcomes given recent changes to STEMI guidelines.
Methods
All patients presenting to the Alfred Hospital, a tertiary referral hospital, between
1 January 2010 and 31 December 2015 undergoing PCI for STEMI were identified. Detailed
review of their procedure reports was performed and 30-day and 12-month clinical outcomes
were recorded including major adverse cardiac events (MACE).
Results
There was a total of 445 patients aged 60.6 ± 12.4 years with 369 (82.9%) male. There was a significant increase in radial access
use over the 6-year period 0/49 (0%) in 2010 vs 56/113 (49.6%) in 2015 (p < 0.01). There was a significant reduction in the use of IIb/IIIa receptor antagonists
during the period 29/49 (59%) in 2010 vs 24/113 (21%) in 2015 (p < 0.01) and use of aspiration thrombectomy 15/49 (31%) in 2010 vs 19/113 (17%) in 2015
(p < 0.01). There was no significant reduction in major bleeding over this period with
2/49 (4%) in 2010 vs 5/108 (5%) in 2015 (p = 0.32). Thirty-day and 12-month mortality was also unchanged.
Conclusion
Between 2010 and 2015 there has been a significant increase in the use of radial access
and a reduction in the use of glycoprotein IIb/IIIa antagonists and aspiration thrombectomy
in patients undergoing PPCI. This was not associated with changes in major bleeding
or 30-day or 12-month mortality.
Keywords
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References
- Cardiovascular disease: Australian facts . Cardiovascular disease series no 35 Cat no CVD 53.AIHW, Canberra2011
- Executive summary: heart disease and stroke statistics–2010 update: a report from the American Heart Association. [Erratum appears in Circulation. 2010 Mar 30;121(12):e259].Circulation. 2010; 121: 948-954
- Cardiovascular disease in Europe 2014: epidemiological update.Eur Heart J. 2014; 35: 2929
- 2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction.J Am Coll Cardiol. 2013; 61: e78-e140
- ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation.Eur Heart J. 2012; 33: 2569-2619
- Radial versus femoral access for coronary angiography and intervention in pateints with acute coronary syndromes (RIVAL): a randomized, parallel group, multicentre trial.Lancet. 2011; 377: 1409-1420
- A registry-based randomized trial comparing radial and femoral approaches in women undergoing percutaneous coronary intervention: the SAFE-PCI for Women (Study of Aceess Site for Enhancement of PCI for Women) trial.JACC Cardiovasc Interv. 2014; 7: 857-867
- Radial versus femoral access in patients with acute coronary syndromes undergoing invasive management: a randomised multicentre trial.Lancet. 2015; 385: 2465-2476
- Radial versus femoral randomized investigation in ST-segment elevation acute coronary syndrome: the RIFLE-STEACS (Radial Versus Femoral Randomized Investigation in ST-Elevation Acute Coronary Syndrome) study.J Am Coll Cardiol. 2012; 60: 2481-2489
- Stent thrombosis late after implantation of first-generation drug-eluting stents: a cause for concern.Circulation. 2007; 115 (discussion 55): 1440-1455
- Clinical outcomes with drug-eluting and bare-metal stents in patients with ST-segment elevation myocardial infarction: evidence from a comprehensive network meta-analysis.J Am Coll Cardiol. 2013; 62: 496-504
- Comparison of newer-generation drug-eluting with bare-metal stents in patients with acute ST-segment elevation myocardial infarction: a pooled analysis of the EXAMINATION (clinical Evaluation of the Xience-V stent in Acute Myocardial INfArcTION) and COMFORTABLE-AMI (Comparison of Biolimus Eluted From an Erodible Stent Coating With Bare Metal Stents in Acute ST-Elevation Myocardial Infarction) trials.JACC Cardiovasc Interv. 2014; 7: 55-63
- Stent thrombosis in new-generation drug-eluting stents in patients with STEMI undergoing primary PCI: a report from SCAAR.J Am Coll Cardiol. 2014; 64: 16-24
- Thrombus aspiration during ST-segment elevation myocardial infarction.N Engl J Med. 2013; 369: 1587-1597
- Randomized trial of primary PCI with or without routine manual thrombectomy.N Engl J Med. 2015; 372: 1389-1398
- Outcomes 1 year after thrombus aspiration for myocardial infarction.N Engl J Med. 2014; 371: 1111-1120
- Eptifibatide is noninferior to abciximab in primary percutaneous coronary intervention: results from the SCAAR (Swedish Coronary Angiography and Angioplasty Registry).J Am Coll Cardiol. 2010; 56: 470-475
- Platelet glycoprotein IIb/IIIa inhibition with coronary stenting for acute myocardial infarction.N Engl J Med. 2001; 344: 1895-1903
- Comparison of angioplasty with stenting, with or without abciximab, in acute myocardial infarction.N Engl J Med. 2002; 346: 957-966
- 2011 ACCF/AHA/SCAI guideline for percutaneous coronary intervention: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions.J Am Coll Cardiol. 2011; 58: e44-e122
- Standardized bleeding definitions for cardiovascular clinical trials: a consensus report from the Bleeding Academic Research Consortium.Circulation. 2011; 123: 2736-2747
- Temporal Trends and Outcomes of Patients Undergoing Percutaneous Coronary Interventions for Cardiogenic Shock in the Setting of Acute Myocardial Infarction: A Report From the CathPCI Registry.JACC Cardiovasc Interv. 2016; 9: 341-351
- Comparing percutaneous coronary intervention and thrombolysis in patients with return of spontaneous circulation after cardiac arrest.Clinics. 2013; 68: 523-529
- Transradial percutaneous coronary intervention in cardiogenic shock: a single-center experience.Am Heart J. 2013; 165: 280-285
- Bivalirudin during primary PCI in acute myocardial infarction.N Engl J Med. 2008; 358: 2218-2230
- Unfractionated heparin versus bivalirudin in primary percutaneous coronary intervention (HEAT-PPCI): an open-label, single centre, randomised controlled trial. [Erratum appears in Lancet. 2014 Nov 22;384(9957):1848].Lancet. 2014; 384: 1849-1858
- Bivalirudin for patients with acute coronary syndromes.N Engl J Med. 2006; 355: 2203-2216
- Time of onset of symptoms of acute myocardial infarction.Am J Cardiol. 1990; 66: 140-144
- Differing circadian patterns of symptom onset in subgroups of patients with acute myocardial infarction.Circulation. 1989; 80: 267-275
- Circadian variation in the frequency of onset of acute myocardial infarction.N Engl J Med. 1985; 313: 1315-1322
- Circadian rhythm and cardiovascular disease.Curr Atheroscler Rep. 2009; 11: 289-295
- Diurnal variation in endothelium-dependent vasodilatation is not apparent in coronary artery disease.Circulation. 2001; 103: 806-812
Article info
Publication history
Published online: July 14, 2017
Accepted:
June 16,
2017
Received in revised form:
June 5,
2017
Received:
March 20,
2017
Identification
Copyright
© 2017 Published by Elsevier B.V. on behalf of Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ).
