Barbash IM et al. – In patients with ST–elevation myocardial infarction (STEMI), primary PCI failure is uncommon. It is associated with worse short– and long–term clinical outcome compared with a successful procedure. Special care should be taken when percutaneous coronary intervention (PCI) is performed in women at higher risk for failure when presenting with STEMI.

• A clinical database of consecutive patients who underwent primary or rescue PCI from 1993 to 2011 was used to compare patients with successful versus failed PCI.
• Clinical follow–up was obtained in–hospital, at 30 days and at 1 year.

• Of 2900 patients fulfilling the inclusion criteria, 111 (3.98%) had failed PCI.
• Patients who had failed PCI were older (65 vs. 61 years), were more likely to be women (46% vs. 32%), were more likely to have previous peripheral vascular disease (19% vs. 11%), previous PCI (29% vs. 20%), and were more likely to present with cardiogenic shock (25% vs. 11%) (all P < 0.05).
• Multivariable logistic regression analysis identified female gender (OR 1.54; 95% CI 1.01–2.38), cardiogenic shock (2.07; 1.22–3.49), previous PCI (1.71; 1.08–2.70), and type C lesion (2.47; 1.60–3.82) as independent predictors of PCI failure.
• The in–hospital (18% vs. 4%) and long–term mortality (48% vs. 14%) were worse in the failed PCI group compared to the successful group (P < 0.05).