Search

Background: Early reperfusion therapy with primary percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI) improves left ventricular function and reduces mortality., Aim: To assess the time delay in treatment of patients with STEMI referred to a twenty-four-hour interventional centre located in the vicinity of the centre of Warsaw., Methods: We analysed 350 consecutive STEMI patients admitted to our Department between October 2005 and September 2006. The majority of the patients - 244 (69.7%), were admitted via hospitals without an interventional department. Sixty-two (17.7%) patients were transported directly by ambulance from home, 34 (9.7%) from a community health centre and 10 patients (2.9%) came by themselves from home or work. A detailed interview concerning the time of symptom onset was conducted in 342 patients (97.7%)., Results: Sixty-two (18%) patients arrived at the interventional centre within the first 2 hours from symptom onset: 6 women (5.5% of all women in the study population) and 56 (24.1%) men (p <0.0001). Within the first 2 hours, 32 (13.1%) patients were admitted via another hospital and 20 (32.2%) directly by ambulance (p <0.001). During the first 7 days of hospitalisation the following patients died: 2 (3.2%) patients admitted within the first 2 hours via another hospital, 6 (3.4%) patients among 178 admitted between 2 and 6 hours after pain onset, 4 (8.3%) among 48 admitted between 6 and 12 hours and 8 (14.8%) among 54 patients with the pain duration over 12 hours (p <0.02). During the first 7 days of hospitalisation 8 (3.3%) patients admitted within the first 6 hours after pain onset died compared with 12 (11.8%) admitted later (p <0.003)., Conclusions: In the interventional centre located near the centre of Warsaw symptom-onset-to-door time was 120 minutes only in 18% of patients with STEMI. Almost 70% of patients underwent interhospital transfer for primary PCI. Prolongation of the time from onset of symptoms to successful PCI worsened prognosis. When transporting patients with acute coronary syndrome, efforts should be made to avoid district hospitals without a catheterisation laboratory. Direct transportation by ambulance or helicopter with educated staff equipped with ECG teletransmission data, which may substantially shorten time to treatment, should be preferred.

Background: Diabetic patients with acute coronary syndrome (ACS) have higher mortality risk than non-diabetic patients. No data are available on long-term results of interventional treatment of ACS in diabetic patients aged > or =80 years., Aim: To compare the effects of primary angioplasty (pPCI) on short- and long-term outcome in diabetic patients > or =80 years with ST-elevation myocardial infarction (STEMI) compared to those without diabetes mellitus (DM) of similar age., Methods: In 63 consecutive patients (22% with diabetes mellitus) aged 80-93 years (mean 83+/-3) with ST elevation ACS (ACS-STE) coronary angiography was performed. Severity of coronary atherosclerosis, effects of pPCI, one-day mortality, in-hospital mortality and one-year mortality were studied., Results: Severity of coronary atherosclerosis measured by angiographic Gensini score and author's own score was similar in diabetic and non-diabetic patients (23.25+/-9.6 vs. 20.6+/-10.2; NS, and 9.1+/-6.0 vs. 8.1+/-5.4; NS, respectively). In 78.6% of diabetic subjects and in 69.4% of those without DM, pPCI was performed. Successful pPCI, defined as TIMI 3 flow and residual infarct related stenosis <20%, was obtained in 92.2% of patients with DM compared to 83.7% of non-diabetics (NS). One-day mortality was 7.1 vs. 6.1% (NS), in-hospital mortality was 7.1 vs. 17.4% (NS). Successful pPCI reduced 30-day mortality threefold (OR=0.31; p <0.05). Contrast-induced nephropathy occurred in 35.7% of diabetic patients compared to 26.5% of those without diabetes (NS) Contrast-induced nephropathy increased risk for in-hospital mortality fivefold (p <0.02). No significant correlation between DM or baseline glucose level and in-hospital mortality was found. During one-year follow-up mortality rate in diabetic patients was 38.5% compared to 7.3% of those without diabetes (p <0.01). One-year mortality predictors were: age (OR=1.27; p=0.0047), metabolic syndrome (OR=4.4; p <0.04), type 2 diabetes (OR=5.25; p <0.02), insulin treatment (OR=5.7; p <0.03), baseline glucose level (OR=1.01; p <0.007), maximum CK-mass level (OR=1.006; p <0.05), noninvasive STEMI management (OR=5.0; p <0.02), and stroke (OR=7.5; p <0.006). Stroke (OR=40.0; p <0.005) and diabetes (OR=6.2; p <0.01) were identified by multivariable analysis as independent risk factors of one-year mortality., Conclusions: In patients with DM aged > or =80 years with ACS-STE, severity of coronary atherosclerosis and in-hospital prognosis after pPCI seems to be similar to subjects in the same age without DM. Diabetes mellitus is an independent risk factor of one-year mortality after successful pPCI.