Results of primary percutaneous coronary intervention in a consecutive group of patients with acute ST elevation myocardial infarction at a tertiary Australian centre.
BACKGROUND
Multicentre randomized controlled trials (RCT) of primary percutaneous coronary intervention (PCI) for ST elevation myocardial infarction (STEMI) have consistently shown lower mortality compared with fibrinolysis, if carried out in a timely manner. Although primary PCI is now standard of care in many centres, it remains unknown whether results from RCT of selected patients are generalizable to a 'real-world' Australian setting. The primary goal of this study was to evaluate whether a strategy of routine invasive management for patients with STEMI can achieve 30-day and 12-month mortality rates comparable with multicentre RCT. Secondary goals were to determine 30-day mortality rates in prespecified high-risk subgroups, and symptom-onset- and door-to-balloon-inflation times.


METHODS
A retrospective observational study of 189 consecutive patients treated with primary PCI for STEMI in a single Australian centre performing PCI for acute STEMI.


RESULTS
All-cause mortality was 6.9% at 30 days, and 10.4% at 12 months. Mortality in patients presenting without cardiogenic shock was low (2.4% at 30 days; 5.0% at 12 months), whereas 12-month mortality in patients with shock was higher, particularly in the elderly (29.4% for patients <75 years; 85.7% for patients > or =75 years, P = 0.01). Symptom-onset-to-balloon-inflation time was < or =4 h in 56% of patients (median 231 min); however, a door-to-balloon time of <90 min was achieved in only 20% (median 133 min).


CONCLUSIONS
Mortality and symptom-onset-to-balloon-inflation times reported in RCT of primary PCI for STEMI are generalizable to 'real-world' Australian practice; however, further efforts to reduce door-to-balloon times are required.
van Gaal
W J
WJ
Department of Cardiology, The John Radcliffe, Oxford, United Kingdom. bill.vangaal@conted.ox.ac.uk
Clark
D
D
Barlis
P
P
Lim
C C S
CC
Johns
J
J
Horrigan
M
M
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D001315:Australia; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D015912:Thrombolytic Therapy / Q000401:mortality*; D016896:Treatment Outcome