Primary Percutaneous Coronary Intervention in Patients with Acute Myocardial Infarction

Abstract

Background: Primary percutaneous coronary intervention (primary PCI) is the method of choice in establishing reperfusion in acute myocardial infarction (AMI) patients. The aim of this study was to determine the success rate of primary PCI in a university medical center in Iran with a view to promoting it as a first-line therapy in patients with AMI, especially in centers with established catheterization labs across the country.

Methods: All cases of AMI admitted between September 2001 and September 2005 underwent primary PCI. The achieved thrombolysis in myocardial infarction (TIMI) flow was recorded, and the patients were followed during the hospital admission for major adverse cardiac events (MACE).

Results: A total of 180 patients, consisting of 36 females and 144 males, with a mean age of 56±2.1 years were included in the study. The target vessel was the left anterior descending artery in 66.1%, right coronary artery in 27.2%, and left circumflex artery in 6.7% of the cases. The respective rate of anatomical and procedural success was 94.4% and 90%. The rates of mortality, coronary artery bypass grafting (CABG), and reinfarction were 6.7%, 1.1%, and 2.2%, respectively. Most patients were discharged with no complications in less than a week. Anatomical success in patients <65 years old was 95% versus 92.5% for those ³ 65 years of age. Procedural success in patients <65 years of age was 93.6% versus 77.5% for those ³65 years old (P<0.05). No significant relation was detected between the success rate and sex, target vessel, or major coronary artery disease risk factors. More patients in the mortality group had a longer door-to-balloon (DTB) time compared to the surviving group (P<0.05).

Conclusion: In light of the results of this study, primary PCI may also be practiced as the therapy of choice for AMI patients in centers with established equipment in our region with acceptable rates of MACE and complications. Better procedural success rates are achieved in younger patients and in those with a shorter DTB time.