Timing, setting and incidence of cardiovascular complications in patients with acute myocardial infarction submitted to primary percutaneous coronary intervention.
BACKGROUND
At the Istituto di Clinica Medica Generale e Cardiologia (Florence, Italy), the widespread use of percutaneous coronary intervention (PCI) has markedly changed the hospital course of patients with acute myocardial infarction (AMI). These patients are typically transferred to the coronary care unit (CCU) only after primary PCI, whereas during the thrombolytic era, patients were first admitted to CCU before reperfusion.


OBJECTIVE
The incidence, timing and setting of complications from symptom onset to hospital discharge in 689 consecutive AMI patients undergoing PCI were evaluated.


RESULTS
Ventricular fibrillation occurred in 11% of patients, and most episodes (94.7%) occurred before or during PCI. Of all patients, 6.3% developed complete atrioventricular block (CAVB), and in 86.3% of these cases, the CAVB occurred before or during PCI; in 94.5%, a CAVB resolution occurred in the catheterization laboratory (CL). Thirty-one patients (4.5%) had impending shock on admission to the CL. Cardiogenic shock developed in 2 9 patients (4.2%), mostly in the prehospital phase or in the CL. Only four patients (less than 1%) developed cardiogenic shock later during their hospital course. Similarly, circulatory and ventilatory support, as well as temporary pacing and cardiac defibrillation, were used mostly in the prehospital phase or in the CL. During the CCU stay, 45 patients (6.5%) had hemorrhagic or vascular complications, and the incidence of post-PCI ischemia and early reocclusion of the culprit vessel were low (2.1% and 0.6%, respectively). Thus, cardiac complications usually associated with AMI were observed mainly before hospital admission or in the CL during the reopening of the target vessel. These complications were rarely observed after a successful PCI.


CONCLUSIONS
For AMI patients, the CL is not only the site of PCI, it is also where most life-threatening cardiac complications are observed and treated.
Giglioli
Cristina
C
Coronary Care Unit, Instituto di Clinica Medica Generale e Cardiologia, Florence, Italy. cristinagiglioli@yahoo.it
Margheri
Massimo
M
Valente
Serafina
S
Comeglio
Marco
M
Lazzeri
Chiara
C
Chechi
Tania
T
Armentano
Corinna
C
Romano
Salvatore Mario
SM
Falai
Massimilano
M
Gensini
Gian Franco
GF
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D001145:Arrhythmias, Cardiac / Q000188:drug therapy / Q000209:etiology*; D006328:Cardiac Catheterization / Q000009:adverse effects; D017023:Coronary Angiography; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D009203:Myocardial Infarction / Q000150:complications* / Q000401:mortality / Q000628:therapy; D012770:Shock, Cardiogenic / Q000209:etiology* / Q000628:therapy; D013997:Time Factors; D016896:Treatment Outcome