Clinical manifestations and effects of primary percutaneous coronary intervention for patients with delayed pre-hospital time in acute myocardial infarction

• Published in: Journal of cardiology 2010-09, Vol.56 (2), p.204-210
• Main Authors: Nomura, Tetsuya, MD, Tatsumi, Tetsuya, MD, Sawada, Takahisa, MD, FJCC, Kojima, Akiteru, MD, Urakabe, Yota, MD, Enomoto-Uemura, Satoko, MD, Nishikawa, Susumu, MD, Keira, Natsuya, MD, Nakamura, Takeshi, MD, Matoba, Satoaki, MD, Yamada, Hiroyuki, MD, Matsumuro, Akiyoshi, MD, Shirayama, Takeshi, MD, Shiraishi, Jun, MD, Kohno, Yoshio, MD, Kitamura, Makoto, MD, Furukawa, Keizo, MD, FJCC, Matsubara, Hiroaki, MD
• Format: Article
• Language: English
• Subjects: Age Factors; Aged; Angioplasty, Balloon, Coronary; Cardiovascular; Female; Humans; Interventional cardiology; Logistic Models; Male; Myocardial infarction; Myocardial Infarction - mortality; Myocardial Infarction - therapy; Patient Admission; Prognosis; Retrospective Studies; Time Factors; Treatment
• ISSN: 0914-5087; 1876-4738
• DOI: 10.1016/j.jjcc.2010.05.004

Summary Background Prolonged pre-hospital time for acute myocardial infarction (AMI) is associated with decreased indication for primary percutaneous coronary intervention (PCI). However, the efficacy of primary PCI in AMI patients with prolonged pre-hospital time has not been fully investigated in Japan. Methods and results A total of 3010 consecutive AMI patients admitted to AMI-Kyoto Multi-Center Risk Study Group hospitals were retrospectively analyzed, and the clinical characteristics and in-hospital prognosis of these patients were reviewed. Patients with pre-hospital delay [elapsed time (ET) > 12 h] had a lower frequency of Killip ≥ 3 (9.3%) and less frequently received primary PCI (77.7%) compared with patients with ET ≤ 12 h. In the ET > 12 h group, older patients or patients with MI history tended to be complicated by heart failure. Primary PCI was performed for patients with ET > 12 h, irrespective of the severity of heart failure [Killip 1 (78.7%) vs Killip ≥ 2 (74.0%); p = 0.3827]. On multivariate logistic regression analysis, age [odds ratio (OR) 1.053], MI history (OR 2.860), Killip ≥ 2 (OR 10.235), and multi-vessels or left main coronary artery as culprit (OR 11.712) were significant independent positive predictors of in-hospital mortality for patients with ET > 12 h. Practice of primary PCI was not a significant negative predictor for patients with ET > 12 h (OR 0.812), but it was for patients with ET ≤ 12 h (OR 0.425). Conclusions These findings indicate that patients with ET > 12 h have a less severe condition and less frequently receive primary PCI compared with patients with ET ≤ 12 h. Although primary PCI is often performed for these patients irrespective of the severity of heart failure, no preferable effect of primary PCI on the in-hospital mortality is demonstrated. In contrary, practice of primary PCI is a significant negative predictor of in-hospital mortality for patients with ET ≤ 12 h.