Emergency percutaneous coronary interventions for acute myocardial infarction with ST-segment elevation in a regional hospital: a quality control study.
BACKGROUND
An invasive approach of acute myocardial infarction with ST-segment elevation (STEMI) with primary percutaneous coronary intervention (PCI) is currently considered as the most efficient revascularisation strategy and is performed around-the-clock in tertiary hospitals. The present study is aimed at investigating the short term outcome of primary PCI eligible patients after STEMI in a regional institution (CHCV, Sion) in comparison to a University Hospital (CHUV, Lausanne).


METHODS
From January the 1st to December the 31st 2002, all consecutive STEMI patients of both centres who had an emergency coronary arteriography were included in the analysis. Clinical and angiographic data were retrospectively collected. The primary end point was the combined incidence of in-hospital death, reinfarction, and target vessel revascularisation (TVR) at 7 days.


RESULTS
The analysis included 58 patients in the CHVC (60+/-13 years, 16% of whom were female) and 160 patients in the CHUV (63+/-12 years, 25% were female). Both populations were identical according to the severity of coronary artery disease and distribution of risk factors, except for smokers (55% in CHCV, 39% CHUV, p=0.04). Most of the patients were treated by PCI in both centres (80% CHCV versus 86% CHUV, p=NS). A low proportion in both groups underwent urgent surgical treatment (3.5% CHCV versus 5.5% CHUV, p=NS). At 7 days, adverse events free survival was not statistically different.


CONCLUSIONS
These results were expected because the CHCV fulfils the international guidelines criteria for performance of emergency angioplasty. Our study demonstrates that around-the-clock primary PCI for acute STEMI can safely be done in a regional hospital (CHCV Sion) providing there is strict adherence to all aspects of international guidelines.
Sierro
Christophe
C
Unit of Cardiology, Regional Hospital (CHCV), Sion, Switzerland. Christophe.Sierro@chuv.ch
Berger
Alexandre
A
Eeckhout
Eric
E
Vogt
Pierre
P
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods / Q000401:mortality / Q000592:standards*; D004632:Emergency Medical Services / Q000379:methods / Q000592:standards*; D005260:Female; D005500:Follow-Up Studies; D006764:Hospitals, Community / Q000379:methods / Q000592:standards*; D006785:Hospitals, University / Q000592:standards; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D011786:Quality Control; D012189:Retrospective Studies