Key result
In-hospital mortality for STEMI patients treated with primary PCI remained stable at 9.1% over a 10-year period (p=0.421 for trend), despite improvements in door-to-balloon time and care quality.
Cohort (n=878)
No
p-value: p=0.421
Despite improvements in door-to-balloon times and increased use of evidence-based therapies, in-hospital mortality for STEMI patients undergoing primary PCI remained stable over 10 years due to increased disease severity on presentation and a rise in non-cardiovascular deaths.
It is unknown whether there has been any change in the causes of death for acute ST-segment elevation myocardial infarction (STEMI) in the era of aggressive reperfusion. We analyzed the direct causes of in-hospital death in patients with STEMI treated with primary percutaneous coronary intervention (PCI) in a tertiary referral center over the past 10 years.We retrospectively analyzed 878 STEMI patients treated with primary PCI in our hospital between January 2005 and December 2014. There were no significant changes in the age and sex of patients, but the prevalence of hypertension and smoking decreased. STEMI severity increased with more patients in Killip classification > 2. The number of out-ofhospital cardiac arrest events also increased over the 10 years. Symptom onset-to-door time did not change in the 10year study period. The care quality was improved with shorter door-to-balloon time for primary PCI and increased use of dual antiplatelet therapy. The all-cause in-hospital mortality was 9.1%, which did not vary over the 10 years. Multivariable analysis showed that Killip classification > 2 was the most important determinant of death. Cardiogenic shock was the major cause of cardiovascular death. There was an increase in non-cardiovascular causes of death in the most recent 3 years, with infection being a major problem.Despite improvement in care quality for STEMI, the in-hospital mortality did not decrease in this tertiary referral center over these 10 years due to increased disease severity and non-cardiovascular causes of death.
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Lee et al. (2016) conducted a cohort in ST-segment elevation myocardial infarction (STEMI) (n=878). Primary percutaneous coronary intervention (PCI) over a 10-year period vs. Temporal trends (2005-2008 vs 2009-2011 vs 2012-2014) was evaluated on All-cause in-hospital mortality (p=0.421). In-hospital mortality for STEMI patients treated with primary PCI remained stable at 9.1% over a 10-year period (p=0.421 for trend), despite improvements in door-to-balloon time and care quality.
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