Clinical manifestations and effects of primary percutaneous coronary intervention for patients with delayed pre-hospital time in acute myocardial infarction.
BACKGROUND
Prolonged pre-hospital time for acute myocardial infarction (AMI) is associated with decreased indication for primary percutaneous coronary intervention (PCI). However, the efficacy of primary PCI in AMI patients with prolonged pre-hospital time has not been fully investigated in Japan.


RESULTS
A total of 3010 consecutive AMI patients admitted to AMI-Kyoto Multi-Center Risk Study Group hospitals were retrospectively analyzed, and the clinical characteristics and in-hospital prognosis of these patients were reviewed. Patients with pre-hospital delay [elapsed time (ET)>12 h] had a lower frequency of Killip≥3 (9.3%) and less frequently received primary PCI (77.7%) compared with patients with ET≤12 h. In the ET>12 h group, older patients or patients with MI history tended to be complicated by heart failure. Primary PCI was performed for patients with ET>12 h, irrespective of the severity of heart failure [Killip 1 (78.7%) vs Killip≥2 (74.0%); p=0.3827]. On multivariate logistic regression analysis, age [odds ratio (OR) 1.053], MI history (OR 2.860), Killip≥2 (OR 10.235), and multi-vessels or left main coronary artery as culprit (OR 11.712) were significant independent positive predictors of in-hospital mortality for patients with ET>12 h. Practice of primary PCI was not a significant negative predictor for patients with ET>12 h (OR 0.812), but it was for patients with ET≤12 h (OR 0.425).


CONCLUSIONS
These findings indicate that patients with ET>12 h have a less severe condition and less frequently receive primary PCI compared with patients with ET≤12 h. Although primary PCI is often performed for these patients irrespective of the severity of heart failure, no preferable effect of primary PCI on the in-hospital mortality is demonstrated. In contrary, practice of primary PCI is a significant negative predictor of in-hospital mortality for patients with ET≤12 h.
Nomura
Tetsuya
T
Department of Cardiovascular Medicine, Nantan General Hospital, 25, Yagi-Ueno, Yagi-cho, Nantan city, Kyoto, 629-0197 Japan. t2-ya@nike.eonet.ne.jp
Tatsumi
Tetsuya
T
Sawada
Takahisa
T
Kojima
Akiteru
A
Urakabe
Yota
Y
Enomoto-Uemura
Satoko
S
Nishikawa
Susumu
S
Keira
Natsuya
N
Nakamura
Takeshi
T
Matoba
Satoaki
S
Yamada
Hiroyuki
H
Matsumuro
Akiyoshi
A
Shirayama
Takeshi
T
Shiraishi
Jun
J
Kohno
Yoshio
Y
Kitamura
Makoto
M
Furukawa
Keizo
K
Matsubara
Hiroaki
H
D000367:Age Factors; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D009203:Myocardial Infarction / Q000401:mortality* / Q000628:therapy*; D010343:Patient Admission; D011379:Prognosis; D012189:Retrospective Studies; D013997:Time Factors