title: Incidence, predictors, and outcomes of failed primary percutaneous coronary intervention: a 10-year contemporary experience.
abstract: BACKGROUND
  Limited contemporary data exist regarding the incidence, predictors, and outcomes of failure of primary percutaneous coronary intervention (PCI) in the treatment of ST-segment elevation myocardial infarction (STEMI).
  
  
  METHODS
  In this registry-based retrospective cohort study, all consecutive unselected patients (n=1725) who were hospitalized for STEMI and underwent primary PCI from January 2001 to December 2010 were included. PCI failure was defined as a final diameter stenosis greater than 30% or postdilatation Thrombolysis in Myocardial Infarction (TIMI) flow grade of 2 or less. We examined the predictors and survival among patients who failed primary PCI.
  
  
  RESULTS
  The overall PCI failure rate was 5.4% (94 of 1725 procedures). After adjusting for prespecified baseline characteristics, independent predictors of PCI failure included age greater than 65 years (P=0.02), procedure date between 2001 and 2005 (P=0.05), night-time PCI (P=0.008), calcific lesion (P=0.008), and lower preprocedural TIMI flow grade (P=0.006). Failed PCI was associated with a 1-year mortality rate of 22% as compared with 4.2% in the successful PCI group (P<0.001). Conservative medical management was preferred in the majority of patients with failed PCI (n=78, 83%). Patients who underwent emergent surgery (n=11), conservative management (n=78), and redo PCI (n=5) experienced 30-day mortality rates of 27, 16, and 0%, respectively.
  
  
  CONCLUSIONS
  Primary PCI failure in the setting of STEMI is not rare. It is associated with high-risk patient-related and angiographic-related characteristics. Primary PCI failure is associated with early and late mortality.
authors.affiliation: aDepartment of Cardiology, Rabin Medical Center, Petah-Tikva, Israel bDepartment of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors.forename: Amos
authors.initials: A
authors.lastname: Levi
authors.forename: Ran
authors.initials: R
authors.lastname: Kornowski
authors.forename: Muthiah
authors.initials: M
authors.lastname: Vaduganathan
authors.forename: Alon
authors.initials: A
authors.lastname: Eisen
authors.forename: Hana
authors.initials: H
authors.lastname: Vaknin-Assa
authors.forename: Salma
authors.initials: S
authors.lastname: Abu-Foul
authors.forename: Eli I
authors.initials: EI
authors.lastname: Lev
authors.forename: David
authors.initials: D
authors.lastname: Brosh
authors.forename: Tamir
authors.initials: T
authors.lastname: Bental
authors.forename: Abid R
authors.initials: AR
authors.lastname: Assali
mesh_terms: D039602:After-Hours Care; D000367:Age Factors; D000368:Aged; D003326:Coronary Circulation; D023921:Coronary Stenosis / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects* / Q000401:mortality; D016016:Proportional Hazards Models; D012042:Registries; D019233:Retreatment; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D017211:Treatment Failure; D061205:Vascular Calcification / Q000150:complications / Q000628:therapy