Clinical predictors for failure of percutaneous coronary intervention in ST-elevation myocardial infarction
Journal of Interventional Cardiology, 05/07/2012Barbash 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).
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