The efficiency of percutaneous coronary interventions in a Regional Vascular Center with regard to baseline risk, the significance of infarction-related artery and the number of affected arteries

Objective. The aim of the study was to evaluate the efficiency of primary percutaneous coronary interventions (PCIs) in patients with ST segment elevation acute coronary syndrome (STE ACS) hospitalized in a Regional Vascular Center (RVC), taking into account the initial mortality risk, including that one assessed by TIMI, the significance of infarction-related artery (IRA) and the number of affected coronary arteries (CA) in different age groups.

Materials and methods. The study included 337 patients with STE ACS admitted at the Regional Vascular Center (RVC) in the initial 6 months after RVC opening at the N. V. Sklifosovsky Research Institute for Emergency Medicine in 2023. The patient age ranged from 26 to 99 years old: there were 176 patients under 65 years, 88 patients aged from 65 to 75 years, and 73 patients over 75. Primary PCI was performed in 321 patients, including 192, 47, and 82 patients in the first 6, 6–12, and 12–72 hours, respectively. All patients were assessed for baseline mortality risk (MR), including quantitative TIMI assessment, ECG, and angiographic signs of reperfusion; autopsy data were available for 44 deceased patients.

Results. When assessing the MR predictors, the most significant of them among the patients hospitalized in the first 6 hours were: BP < 90 mm Hg while on sympathomimetics, cardiopulmonary resuscitation (CPR) with a long-term use of a closed-chest cardiac massage device, and mechanical lung ventilation (MLV). In later study periods, the number of people aged 65–75 years and over 75 years increased. In older age groups, the initial TIMI-assessed MR was higher; three-vessel coronary lesions became more frequent as shown by coronary angiography data, and the angiographic success was less frequently achieved. When restoring the blood flow through left anterior descending artery (LAD), the ST segment reduction that had exceeded 70 % and 50–70 % made 20 % and 46 %, with 55 % and 33 % for the right coronary artery (RCA) and circumflex branch (CxB), respectively. Mortality rates in cases of hospital admission in the first 6, 6–12, and 12–72 hours were 10.9 %, 8.5 %, and 17.1 %, respectively; and taking into account different age groups, the figures were 4.6 %, 20 % and 22.4 % among patients under 65, from 65–75, and over 75 years old, respectively. Fatal outcomes due to fatal complications with prolonged CPR were predetermined by high prehospital mortality risk, associated with unresolved complications that arose during complex interventions for three-vessel disease were associated with a risk that increased during the procedures themselves.

Conclusion. The presented data have shown that the efficiency of primary PCI in patients hospitalized in the RVC depends on the initial MR, the complexity of the interventions associated with the significance of the IRA, and the number of affected coronary arteries. In patients admitted with fatal complications, and prolonged CPR, the IRA blood flow restoration does not prevent fatal outcomes. Angiographic success is reduced in interventions on the LAD in patients with a three-vessel disease, which is more often present in older age groups. Sudden progression of acute heart failure (AHF) during the procedures is complicated by the exacerbation of concomitant pathology, development of multiple organ failure. A comparative assessment of the efficiency of coronary interventions, taking into account mortality rates, requires studying a correlation with the initial risk or the comparison between different age groups.

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