title: Clinical predictors for failure of percutaneous coronary intervention in ST-elevation myocardial infarction.
abstract: BACKGROUND
  Failed percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) is associated with adverse outcome. With recent improvements in PCI techniques, the incidence and predictors for failed primary PCI are unclear.
  
  
  METHODS
  A clinical database of consecutive patients who underwent primary or rescue PCI from 1993 to 2011 was used to compare patients with successful versus failed PCI. Clinical follow-up was obtained in-hospital, at 30 days and at 1 year.
  
  
  RESULTS
  Of 2900 patients fulfilling our inclusion criteria, 111 (3.98%) had failed PCI. Patients who had failed PCI were older (65 vs. 61 years), were more likely to be women (46% vs. 32%), were more likely to have previous peripheral vascular disease (19% vs. 11%), previous PCI (29% vs. 20%), and were more likely to present with cardiogenic shock (25% vs. 11%) (all P < 0.05). Multivariable logistic regression analysis identified female gender (OR 1.54; 95% CI 1.01-2.38), cardiogenic shock (2.07; 1.22-3.49), previous PCI (1.71; 1.08-2.70), and type C lesion (2.47; 1.60-3.82) as independent predictors of PCI failure. The in-hospital (18% vs. 4%) and long-term mortality (48% vs. 14%) were worse in the failed PCI group compared to the successful group (P < 0.05).
  
  
  CONCLUSIONS
  In patients with STEMI, primary PCI failure is uncommon. It is associated with worse short- and long-term clinical outcome compared with a successful procedure. Special care should be taken when PCI is performed in women at higher risk for failure when presenting with STEMI.
authors.affiliation: Interventional Cardiology, Washington Hospital Center, Washington, DC 20010, USA.
authors.forename: Israel M
authors.initials: IM
authors.lastname: Barbash
authors.forename: Itsik
authors.initials: I
authors.lastname: Ben-Dor
authors.forename: Rebecca
authors.initials: R
authors.lastname: Torguson
authors.forename: Gabriel
authors.initials: G
authors.lastname: Maluenda
authors.forename: Zhenyi
authors.initials: Z
authors.lastname: Xue
authors.forename: Michael A
authors.initials: MA
authors.lastname: Gaglia
authors.forename: Gabriel
authors.initials: G
authors.lastname: Sardi
authors.forename: Lowell F
authors.initials: LF
authors.lastname: Satler
authors.forename: Augusto D
authors.initials: AD
authors.lastname: Pichard
authors.forename: Ron
authors.initials: R
authors.lastname: Waksman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy*; D012307:Risk Factors; D017211:Treatment Failure