Primary percutaneous coronary intervention without on-site cardiac surgery backup in unselected patients with ST-segment-Elevation Myocardial Infarction: The RIvoli ST-segment Elevation Myocardial Infarction (RISTEMI) registry

Abstract Background Primary percutaneous coronary intervention (PCI) is the preferred reperfusion strategy for patients with ST-segment-elevation myocardial infarction (STEMI), but some concerns remain about its safety and efficacy in centers without on-site cardiac surgery (OCS). Methods The Inferm...

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Published in:Cardiovascular revascularization medicine 2013, Vol.14 (1), p.9-13
Main Authors: Tomassini, Francesco, Gagnor, Andrea, Montali, Nicolò, Infantino, Vincenzo, Tizzani, Emanuele, Tizzani, Paolo, Lanza, Gaetano Antonio, Conte, Maria Rosa, Varbella, Ferdinando
Format: Article
Language:English
Subjects:
Aged
Cardiac Surgical Procedures
Cardiology Service, Hospital
Cardiovascular
Chi-Square Distribution
Coronary Angiography
Emergency Service, Hospital
Feasibility Studies
Female
Health Services Accessibility
Hospitals, Community
Hospitals, High-Volume
Humans
Linear Models
Logistic Models
Male
Middle Aged
Multivariate Analysis
Myocardial Infarction - diagnostic imaging
Myocardial Infarction - mortality
Myocardial Infarction - therapy
Odds Ratio
On-site cardiac surgery
Patient Selection
Percutaneous Coronary Intervention - adverse effects
Percutaneous Coronary Intervention - mortality
Primary percutaneous coronary intervention
Registries
Retrospective Studies
Risk Assessment
Risk Factors
Rome
ST-segment-elevation myocardial infarction
Time Factors
Treatment Outcome
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Summary:Abstract Background Primary percutaneous coronary intervention (PCI) is the preferred reperfusion strategy for patients with ST-segment-elevation myocardial infarction (STEMI), but some concerns remain about its safety and efficacy in centers without on-site cardiac surgery (OCS). Methods The Infermi Hospital in Rivoli, Italy, is a community hospital without OCS with a high volume catheterization laboratory (> 800 PCI and > 150 primary PCI per year), which provides a 24-hour primary PCI service to a population of 583.000 and is only 14 km far from the nearest OCS hospital. We analyzed clinical and procedural data, as well as 30-day outcome, of all STEMI patients treated by primary PCI within 12 hours from symptom onset. Results From September 2001 to June 2010, 1302 patients with a suspect of STEMI underwent urgent coronary angiography. Of these, 1251 (96.1%), underwent primary PCI. A successful myocardial revascularization was achieved in 1172 patients (93.7%). Thirty-day mortality occurred in 7.1%. Multivariate predictors of 30-day mortality were: age ≥ 75 years (OR 3.96, p = 0.0003), left ventricular ejection fraction ≤ 40% (OR 35.0, p = 0.02), cardiogenic shock at presentation (OR 33.4, p < 0.0001), anterior STEMI (OR 1.82, p = 0.036) and total ischemic time ≤ 3 hours (OR 0.55, p = 0.05). Conclusions Primary PCI is a reperfusion strategy feasible and effective in unselected high-risk STEMI patients even in hospitals without OCS with a high volume of routine and emergency interventional procedures.
ISSN:1553-8389
1878-0938
DOI:10.1016/j.carrev.2012.11.004