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Long-term prognosis in an ST-segment elevation myocardial infarction population treated with routine primary percutaneous coronary intervention: From clinical trial to real-life experience
Circulation: Cardiovascular Interventions, 08/21/09

Pedersen S et al. – Findings show that ST-segment elevation myocardial infarction (STEMI) pts treated with contemporary routine primary percutaneous coronary intervention (pPCI) achieve a similar long-term prognosis as pts in the landmark randomized pPCI trial (DANAMI-2). The long-term prognosis was the same regardless of whether the pPCI was performed during off hours or office hours. Thus, pPCI including transportation of pts from noninvasive centers can be applied successfully in a real-life population.

Methods

Study to describe long-term prognosis after routine pPCI in a contemporary consecutive population of pts with presumed STEMI
Comparison with similar results from the landmark DANAMI-2 trial
Identification of a possible impact of time of presentation and referral pattern
Evaluation of long-term prognosis in 1019 presumed STEMI pts, treated by modern routine pPCI during 2004
Analysis of impact of pt presentation to angioplasty center during "off hours" (4 pm-8 am/weekends/holidays) and impact of referral from noninvasive hospitals

Results

At 3 yrs, 20.4% in routinely treated population vs 19.6% in DANAMI-2 trial reached combined endpoint of death, reinfarction, or stroke; all-cause mortality: 13.0% and 13.7%, respectively
Pts admitted during off hours had same risk of reaching combined endpoint of death, reinfarction, or stroke v pts admitted during office hours
Door-to-balloon times of <90 min achieved in 60% among pts admitted directly to an invasive center but only in 40% among transferred pts
Despite this difference, no difference in unadjusted or adjusted long-term prognosis between groups

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