Importance of delayed perfusion with primary angioplasty on short-term mortality in acute myocardial infarction patients.

BACKGROUND: Early primary coronary interventions (PCI) in acute ST elevation myocardial infarction (STEMI) is associated with improved outcome and mortality rate but delayed reperfusion especially after 6 hours is still doubtful in terms of clinical benefits because most myocardial muscle are infarcted after 6 hours of onset of chest pain. OBJECTIVE: The aim of the present study was to compare the mortality rate of patients treated with PCI within 6 hours of symptom onset to those treated between 6 to 24 hours after the onset of STEMI. MATERIAL AND METHOD: The present study included consecutive patients from the data of the Fast Track Registry of King Chulalongkorn Hospital from June 1, 1999 to October 31, 2003 to compare the thirty-day mortality of patients treated with early or delayed PCI (0-6 hours vs. 6-24 hours after symptom of chest pain) for STEMI. RESULTS: Two hundred and sixteen patients who underwent PCI were enrolled. Male gender (82% vs. 64.9%, p = 0.03) and history of smoking (72.1% vs. 50%, p = 0.04) were predominant in the early treatment group (ETG) vs. the delayed treatment group (DTG). Mean age (60.5% vs. 61.03%, p = 0.11), diabetes (31.4% vs. 29.7%, p = 0.82), hypertension (64.0% vs. 54.1%, p = 0.20), dyslipidemia (58.1% vs. 60.8%, p = 0.73), and ejection fraction < 40% (22.8% vs. 32.0%, p = 0.625) were similar in both groups. There were no differences in angiographic finding and hospital management. Door to balloon and total delay time were 124.13 +/- 143.27 min and 407.94 +/- 268.183 min, respectively. The thirty-day mortality (9.01% vs. 12.76%, p = 0.379) and I year mortality (12.4% vs. 16 9%, p = 0.532) were not significantly determined by Log rank test in both groups. As for cardiogenic shock, ETG tended to have a lower thirty-day mortality than DTG but no statistically significant difference (12.5% vs. 50.0%, p = 0.0809). CONCLUSION: The delayed PCI up to 24 hours in STEMI does not increase short-term mortality at thirty days; therefore, it may still have benefit in STEMI patients. However it tended to have higher short-term mortality than early PCI especially in cardiogenic shock but showed no statistical significance.

Comparison of official hours versus non-official hours: percutaneous coronary intervention in acute ST-elevation myocardial infarction patients.

BACKGROUND: Percutaneous coronary intervention (PCI) is now a favorable treatment for acute ST elevation myocardial infarction (STEMI). However, in non-official hours (non-OH), this modality of treatment has a questionable outcome because of the treatment delay. OBJECTIVE: To compare the outcomes of PCI during official hours (OH) with non-OH in acute STEMI patients. MATERIAL AND METHOD: A prospective consecutive registry of PCI in acute ST-elevation MI patients at King Chulalongkorn Memorial Hospital from May 1999 to December 2003 were analyzed. Kaplan Meier survival analysis was used to determine the in-hospital mortality. Multivariate analysis was used to determine the prognostic factors for in-hospital mortality. RESULTS: Two hundred and fifty six consecutive patients (OH-107, non-OH-149) who underwent PCI for acute STEMI were enrolled. Their mean age (61.9 +/- 12.2 vs 60.6 +/- 12.8 y, p = ns), male gender (73.8% vs 73.2%, p = ns), history of diabetes (30.2% vs 33.8%, p = ns), severity of the patients (percent of patients in Killip IV--22.4 vs 21.5, p = ns), ejection fraction (48.7 +/- 15.1 vs 45.9 +/- 14.7, p = ns), cardiopulmonary resuscitation prior PCI (15.0% vs 14.2%, p = ns), anterior MI (55.1% vs 51.0%, p = ns) were similar in both groups. Hypertension was slightly less common (39.6% vs 52.7%, p = 0.04) but smoking was more common (62.6% vs 49.0%, p = 0.03) in OH group. Door to balloon time and decision to balloon time were significantly shorter in the OH group than the non-OH group (67.9 +/- 47 vs 119.6 +/- 83 min, p < 0.001 and 60.8 +/- 35 vs 98.3 min, p < 0.001). However, the total delayed time was not statistically significantly different (402 +/- 316 vs 424 +/- 215, p = 0.55). Angiographic success rate was achieved in 98.1% for the OH group and 94.7% in the non-OH group (p = ns). In-hospital mortality rate was 10.3% and 10.7% respectively. CONCLUSION: The door to balloon time for PCI in acute STEMI patients in the non-OH group was longer than the OH group; however, the total delayed time was not different. The in-hospital mortality rate was similar.

Worse prognosis for women who underwent primary percutaneous coronary intervention for acute ST-elevation myocardial infarction.

BACKGROUND: Many reports have shown that female gender carries a worse prognosis when developing acute myocardial infarction (MI), whether or not reperfusion therapy is used. The primary percutaneous coronary intervention (1-PCI) is currently a preferable treatment for acute ST-elevation MI. However, the data concerning the difference between the outcomes in the treatment of the disease in men and women in Thailand is still insufficient. MATERIAL AND METHOD: A prospective registry of acute ST-elevation MI patients who underwent 1-PCI at King Chulalongkorn Memorial Hospital from June 1999 to December 2002 were analyzed. Kaplan Meier survival analysis is used to determine the in-hospital mortality. RESULTS: The consecutive 184 (F-52, M-131) patients who underwent 1-PCI were recruited. Female subjects were older (66.6 +/- 12 y versus 59.0 +/- 11.6 y, p < 0.01); they also had higher percentage of diabetes (45.1 versus 27.1, p < 0.01), but a fewer number of smoker (17.7 versus 66.2, p < 0.001). The percentage of patients who had cardiogenic shock tended to be higher in women (34.6 versus 19.9, p = 0.08); however, the number of anterior wall MI and ejection fraction were not different. The mean door to balloon time (109 +/- 95 versus 99 +/- 68 minutes) and pain to balloon time (454 +/- 271 versus 372 +/- 298 minutes) were not different in both groups. The angiographic success with TIMI 3 flow was achieved in 92.3% for females and 86.9% for the males. The in-hospital mortality was significantly higher in females (23.1 versus 6.1, p = 0.002). Univariate analyses demonstrated that the feminine gender, cardiogenic shock, smoking, ejection fraction less than 40, cardiac arrest prior PCI and angiographic were the predictors for in-hospital mortality. When using multivariate analyses by Cox proportional model, only cardiogenic shock, history of hypertension and angiographic success were the significant predictors. Women had 2.15 times of in-hospital mortality higher than males; however, the confidence interval cross-over 1 (0.74-6.42) and p value was 0.16. CONCLUSION: Females tend to have a poor prognosis when they develop acute ST-elevation MI which requires treatment with 1-PCI.

Initial and long-term results of coronary angioplasty: a report from King Chulalongkorn Memorial Hospital.

PTCA is one of the treatments for coronary heart disease. But in Thailand, there is no available data on the long-term outcomes of patients who have undergone this procedure. To determine initial and long-term outcomes of patients who underwent percutaneous transluminal coronary angioplasty (PTCA), patients who underwent PTCA from January 1996 to December 1997 were enrolled. The initial results were received from the PTCA registry. The follow-up data were collected from medical records, phone calls and mail. Three hundred and forty patients (male 68.8%) were enrolled. Mean age was 61.8 +/- 10.1 years. Dyslipidemia was the most common risk factor (50.3%), followed by hypertension (44.4%), smoking (40%), and diabetes (33.8%). Indications for PTCA were chronic stable angina (47.9%), unstable angina (22.1%), acute myocardial infarction (4.3%) and post myocardial infarction angina (25.8%). Diseased vessels were left anterior descending (44.8%), right coronary artery (28.0%), left circumflex artery (25.5%), left main artery (0.9%) and saphenous vein grafts (0.8%). Initial case success rate was 93.5 per cent. Stent was implanted in 41.8 per cent of cases. In-hospital mortality rate was 1.2 per cent. Two patients (0.6%) developed Q-wave myocardial infarction (MI). Four patients (1.2%) required emergency bypass surgery (CABG). Major adverse cardiac events occurred in 6 patients (1.8%). Two hundred ninety one patients (85%) had complete follow-up data, mean follow-up time was 990 +/- 326 days. Twenty-one patients died (6.4%) but only 12 (3.5%) were cardiac in origin. Other cardiovascular events were non-fatal MI (1.2%), unstable angina (10.7%), congestive heart failure (4.6%), and chronic stable angina (41.1%). Target lesion revascularization by PTCA was done in 55 patients (16.9%) and CABG was performed in 22 patients (6.7%) Conclusion: PTCA can be performed with a high success rate and low in-hospital complications. Long-term outcomes are acceptable and comparable with Western data.