Long-term prognosis after primary PCI in unselected patients with ST-elevation myocardial infarction.

AIMS: Long-term prognosis of ST segment elevation myocardial infarction (STEMI) in the era of primary percutaneous coronary intervention (pPCI) remains relatively poorly investigated in unselected patients. This study analyzed 8-year follow-up of STEMI patients enrolled in the Florence Acute Myocardial Infarction Registry, a population-based, observational study performed in Italy in 2000-2001.

METHODS: The prognostic effect of pPCI adjusted for clinical and demographic characteristics on a composite end-point of new myocardial infraction, urgent revascularization or death, and on all-cause mortality separately, was assessed in multivariable Cox analysis, calculating hazard ratios and 95% confidence intervals. This analysis is concerned with 875 STEMI patients (mean age 70.6 ± 12.9 years), treated with pPCI (459) or conservatively (416).

RESULTS: After 8 years, 59% of patients had experienced the composite end-point and 49% had died. The multivariable analysis showed a significantly better prognosis in patients receiving pPCI (hazard ratio 0.72, P = 0.001), evident also in the 645 patients who were event-free after the first year of follow-up (hazard ratio 0.72, P = 0.010). Other independent prognostic factors were advanced age, Killip class greater than 1, some cardiovascular or noncardiovascular comorbidities, in-hospital cardiogenic shock, ejection fraction less than 30%, and treatment with aspirin and statin during hospitalization. The beneficial effect of pPCI observed both in cases younger (adjusted hazard ratio 0.65, P = 0.013) and older than 75 years (adjusted hazard ratio 0.65, P = 0.001) was also confirmed considering as outcome all-cause mortality only.

CONCLUSIONS: In unselected STEMI patients, survival advantage from pPCI extends for a long term (8 years). This survival advantage is maintained at advanced ages, thus enforcing the importance of improving delivery of appropriate care to older STEMI patients.