Immediate Result and Long Term Follow-up in Patients Going Under Primary Percutaneous Intervention for ST-Elevation Myocardial Infarction
Background: Primary percutaneous intervention (PCI) is the choice of reperfusion therapy and is significantly superior to thrombolysis in acute ST-elevation myocardial infarction (MI).
Objectives: We did design this study to evaluate the successful rate, early complication and late follow-up of the patients with acute myocardial infarction who referred to Razavi Hospital.
Patients and Methods: In this study, 68 consecutive patients who were admitted by diagnosis of acute coronary myocardial infarction and ST-elevation change in ECG underwent primary PCI by a single high volume operator from March, 2008 to March, 2011. The successful rate, incidence of in Hospital’s main adverse cardiac effects (MACE) and main adverse non-cardiac effects (MANE) and also their impact on one- year cardiac mortality and morbidity were estimated.
Results: The successful rate of primary PCI in this study was estimated to be 100%. MACE occurred in 4 patients (5.8%) (2 deaths and 2 myocardial infarctions) and MANE occurred in 8 patients (11.8%) (7 cases with major or minor bleeding and one with contrast nephropathy). In one- year follow-up of patients who included in the study, surveillance rate was 91.2 % (62 of 68), 13 patients had persistent cardiac symptoms (19.1%), 3 of them were admitted to the hospital with coronary syndromes (4.4%) and just one patients underwent target vessel revascularization (1.5%). 3 patients had to do CABG in the first year (4.4%). Studying the long term MACE and stent type (drug eluting stents vs. bare metal stents) revealed: death; 1 (3.6%) vs. 6 (11.5%), persistent cardiac symp; 3 (10.7) vs. 11 (21.2%), hospitalization; no patient vs. 4 (7.7%) and no TVR in drug eluting stents (DES) group vs. 1 (1.9%) in bare metal stents (BMS) group.
Conclusions: This study confirms that Primary PCI revascularization is the best treatment for the acute ST elevation MI with brilliant acute result and one- year high survival and acceptable cardiac and non-cardiac complications. Studying the effects of using DES and BMS on long term cardiac mortality, morbidity and need to target vessels revascularization (TVR) shows that performing the PCI in the golden time is very important and type of stent is not much important. By reducing the expenses of this procedure through using BMS, we can give this chance to more patients.