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Objective: To demonstrate 11-yr experience of primary percutaneous coronary intervention at King Chulalongkorn Memorial Hospital.
Material and Method: This retrospective descriptive single-center study analyses clinical characteristics, angiographic features and in-hospital outcomes of 772 patients with STEMI who underwent primary percutaneous coronary intervention between 2000 and 2010.
Results: Seven hundred seventy two consecutive patients with STEMI were enrolled in the study. Three-fourth of the patients were male. Mean age was 60.13 years (range 28 to 96 years) and 12.6% were older than 75 years old. Forty-eight percent of patients were referred from hospital without cardiac catheterization facilities. Of these patients 94.4% underwent primary PCI and rescue PCI was done in 5.6% of patients. There were 27% of patients with left ventricular ejection fraction less than 40%, 21% of patients with Killip’s class IV, and 12% suffered cardiac arrest prior to angiography. Median door-to-balloon
time in referred and non-referred patients was 28 and 104.5 minutes, respectively. Ninety-two percent of referred patients and 36% of non-referred patients, door to balloon time were within 90 minutes. About half of the patients had multi-vessels disease at that time of diagnosis. The overall angiographic success rate was 96%. Platelet glycoprotein llb/llla inhibitors were used in two-third of patients and stent placement in 82%. Post procedural Thrombolysis In Myocardial Infarction (TIMI) 3 fl ow was documented in 87%. Intra-aortic balloon pump was used in 15% and thrombus aspiration device in 47%. During hospital stay, in-hospital mortality was 8.5% and 80% of those cases died from cardiac cause. One-third of patients died if they had Killip’s class IV at presentation compared with 1.6% in patients with Killip’s class I-III. In-hospital major adverse cardiovascular event was 10.4%.
Conclusion: During 11 years of primary PCI experience in King Chulalongkorn Memorial Hospital, the angiographic success rate was high with acceptable in-hospital mortality and major adverse cardiac event. This strategy of treatment should be the treatment of choice for patients with STEMI in experienced PCI capable center with 24 hours/7 days availability.
Keywords: Primary percutaneous coronary intervention, ST-segment elevation myocardial infarction, Door to balloon time