Efficacy of percutaneous coronary interventions in acute period of anterior myocardial infarction with consideration of differently organized endovascular radiology service

The aim of the study was a comparative assessment of the treatment efficacy in patients with anterior myocardial infarction with ST segment elevation (STEMI) in two periods: 2003–2007 and 2008–2017 with different endovascular service organization. For 5 years of the first period, the percutaneous coronary interventions (PCIs) were performed in the ERS Unit of the Urgent Cardiology Department. A total of 446 patients were hospitalized; a thrombolytic therapy (TLT) was undertaken in 177 patients, PCI was performed in 155, including primary PCI, life-saving PCI, and PCI after successful TLT in 72, 44, and 39 patients, respectively. Due to daytime working schedule of ERS, PCI was performed within the first 12 hours of STEMI onset in 54 patients, within 12–72 hours in 101 patients selected with regard to an initially high risk of death (RD) according to TIMI. In the 2nd period from 2008 to 2017, the patients’ age was 28–95 years old. Over those 10 years, PCIs were performed in a multi-disciplinary ERS Department working around the clock; 1,052 patients were hospitalized, TLT was undertaken in 177, PCIs were performed in 760, including primary PCI, life-saving PCI, and PCI after successful TLT in 583, 110, and 67 patients, respectively. The PCI ratio in the first 12 and 12–72 hours was 394 to 366. There was no patient selection with regard to the initial high RD. There were 291 and 292 patients without PCI in periods I and II, respectively. A 5-year total and cardio-vascular (CV) post-discharge mortality was assessed in 97 patients treated in period I and in 192 patients treated in period II, and in 128 patients without PCI. The initial RD in patients with anterior STEMI in periods I and II was scored 4.8 or 11.5% and 5.1 or 13%, respectively; in periods I and II the in-hospital mortality was 1.3% and 3.9% after PCI, 7.9% and 13.7% of patients without PCI; 5.6% and 6.7% of patients with and without PCI. In patients with PCI a 5-year post-discharge mortality increased by 13.0% and 16.7%, including the CV mortality that increased by 5.2% and 13.0%; and a 5-year post-discharge mortality in those without PCI increased by 33.6% and 28.9%, respectively. During the first 5 years of the day-time ERS working schedule, the number of PCI, mainly with an initially high RD, increased from 19% to 45%; that was accompanied by a mortality decrease from 12.6% to 3.9%. Over the following 10 years, the number of PCI increased from 57% to 88%; the increased number of unresolved complications during procedures was reflected by more frequent death cases, especially in elderly people; that was accompanied by the mortality increase to 7.1% in the first 7 years, and to 8.6%, 18.6% and 6.9% in the following 3 years due to increased number of hospitalized elderly patients, respectively. Based on the comparative assessment of the presented data, the cause for the differences between the results of PCI performed in the first and second periods lies in a differently organized ERS. Being established as integrated with a cardiology unit, ERS provides a high professional level of service, practical skills and individual patient approach necessary for the successful use of various types of PCI, including delayed PCI, PCIs at late admission, which is typical for STEMI patients of older age with a severe coronary artery disease.

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