title: Temporal changes in the current practice of primary angioplasty: a real life experience of a single high-volume center.
abstract: BACKGROUND
  In the last years, new techniques, drugs and devices have been introduced in the current practice of primary angioplasty (PPCI) and validated by pivotal studies The objective of our study was to evaluate if these studies have led to significant changes on the current practice of primary PCI in our center.
  
  
  METHODS
  From March 2003 to December 2013 1980 patients with ST-segment elevation myocardial infarction underwent PPCI within 12-hours of onset of symptoms. We considered 2 periods of our activity: from 2003 to 2009 (P1) with 1078 patients and from 2010 to 2013 (P2) with 902 patients, and compared them in terms of pharmacological and arterial access strategies and of devices utilization.
  
  
  RESULTS
  In P2 there was a significant increase of radial access (34.1% vs. 1.5, p<0.001), as well as of the use of bivalirudin (22.7% vs. 0.5%, p<0.001) and of new antiplatelet drugs (prasugrel or ticagrelor) (18.3% vs. 0%, p<0.001) whereas the use of GP IIb-IIIa and of intraaortic balloon pump significantly decreased (from 82.3% to 52%, p<0.001 and from 17% to 7.5%, p<0.001 respectively). In the P2 there was a significant increase of the procedural efficacy (97.2% vs. 95.1%, p=0.01) that persisted after the logistic regression adjustment (OR 2.09, CI 95%, 1.04-4.21).
  
  
  CONCLUSIONS
  Our study shows that in the last years, in a high-PCI center, after the publication of pivotal randomized trial and nationwide registries, there were significant changes in the PPCI current practice that could have had an impact on procedural efficacy.
authors.affiliation: Department of Cardiology, Infermi Hospital, Rivoli, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Tomassini
authors.affiliation: Hospital General ISSSTE, Querétaro, Facultad de Medicina, Universidad Autónoma de Querétaro, México.
authors.forename: Lorena
authors.initials: L
authors.lastname: Charrier
authors.affiliation: Department of Cardiology, Infermi Hospital, Rivoli, Italy.
authors.forename: Ferdinando
authors.initials: F
authors.lastname: Varbella
authors.affiliation: Department of Cardiology, Infermi Hospital, Rivoli, Italy. Electronic address: enrico.cerrato@gmail.com.
authors.forename: Enrico
authors.initials: E
authors.lastname: Cerrato
authors.affiliation: Department of Cardiology, Infermi Hospital, Rivoli, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Gagnor
authors.affiliation: Department of Cardiology, Infermi Hospital, Rivoli, Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Rolfo
authors.affiliation: Hospital General ISSSTE, Querétaro, Facultad de Medicina, Universidad Autónoma de Querétaro, México.
authors.forename: Mauro
authors.initials: M
authors.lastname: Echavarria-Pinto
authors.affiliation: Department of Cardiology, Infermi Hospital, Rivoli, Italy.
authors.forename: Sara Palacio
authors.initials: SP
authors.lastname: Restrepo
authors.affiliation: Department of Cardiology, Infermi Hospital, Rivoli, Italy.
authors.forename: Rosa
authors.initials: R
authors.lastname: Nevola
authors.affiliation: Department of Cardiology, Infermi Hospital, Rivoli, Italy.
authors.forename: Denise
authors.initials: D
authors.lastname: Baricocchi
authors.affiliation: Cardiovascular Institute, Hospital Clínico San Carlos, Madrid 28040, Spain; Health Directorate, Infermi Hospital, Rivoli, Italy.
authors.forename: Javier
authors.initials: J
authors.lastname: Escaned
authors.affiliation: Cardiovascular Institute, Hospital Clínico San Carlos, Madrid 28040, Spain; Health Directorate, Infermi Hospital, Rivoli, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Minniti
authors.affiliation: Department of Public Health and Pediatrics, University of Turin, Turin, Italy; Department of Cardiology, Mauriziano Hospital, Turin, Italy.
authors.forename: Maria Rosa
authors.initials: MR
authors.lastname: Conte
authors.affiliation: Department of Clinical and Biological Sciences, University of Turin, Turin, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Berchialla
authors.affiliation: Department of Clinical and Biological Sciences, University of Turin, Turin, Italy.
authors.forename: Maria Michela
authors.initials: MM
authors.lastname: Gianino
mesh_terms: D054058:Acute Coronary Syndrome / Q000628:therapy*; D000368:Aged; D017130:Angioplasty / Q000379:methods* / Q000706:statistics & numerical data*; D000991:Antithrombins / Q000627:therapeutic use; D005260:Female; D006629:Hirudins; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D010446:Peptide Fragments / Q000627:therapeutic use; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011994:Recombinant Proteins / Q000627:therapeutic use; D012042:Registries; D016896:Treatment Outcome
chemical_list: D000991:Antithrombins; D006629:Hirudins; D010446:Peptide Fragments; D010975:Platelet Aggregation Inhibitors; D011994:Recombinant Proteins; C074619:bivalirudin
keywords: Acute myocardial infarction; Primary angioplasty; Temporal changes of primary angioplasty