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Direct stenting is an independent predictor of improved survival in patients undergoing primary percutaneous coronary intervention for ST elevation myocardial infarction
- Source :
- European heart journal. Acute cardiovascular care. 3(4)
- Publication Year :
- 2014
-
Abstract
- Randomised trials have shown that direct stenting (DS) is associated with improved markers of reperfusion during primary percutaneous coronary intervention (PPCI) for ST elevation myocardial infarction (STEMI). However, data evaluating its impact on long-term clinical outcomes are lacking. We set out to evaluate the effect of DS on mortality in a contemporary population of patients undergoing PPCI for STEMI.Consecutive patients undergoing PPCI for STEMI at two high-volume UK heart attack centres between September 2008- December 2010 (n=1562) were included in the analysis. Local databases were analysed for patient demographics, as well as details on PPCI strategy, including use of DS versus predilatation (PD) followed by stenting, manual thrombus aspiration (MT) and glycoprotein IIb/IIIa inhibitors (GPIs). National databases were interrogated for in-hospital, 30-day and one-year mortality. To determine the impact of PPCI strategy on one-year survival, multivariate logistic analysis was performed.Altogether 489 patients underwent DS (31.3%) and 1073 (68.7%) received PD prior to stenting. Patients receiving DS had reduced mortality at 30 days (2.04 versus 4.66%, p=0.01) and one year (3.27 versus 8.48%, p=0.0001). After multivariate adjustment, PD remained an independent predictor of one-year mortality (odds ratio 2.42, 95% confidence interval 1.08-5.45, p=0.032) along with age, cardiogenic shock, number of diseased vessels, and left main or proximal left anterior descending artery intervention. However, neither GPI use nor MT improved survival in either univariate or multivariate analyses.In a contemporary, unselected population of patients undergoing PPCI for STEMI, DS - when compared with stenting after PD - is independently predictive of improved 30-day and one-year survival.
- Subjects :
- Male
medicine.medical_specialty
medicine.medical_treatment
Population
Myocardial Infarction
Improved survival
Kaplan-Meier Estimate
Critical Care and Intensive Care Medicine
Independent predictor
Percutaneous Coronary Intervention
St elevation myocardial infarction
Internal medicine
medicine
Direct stenting
Humans
In patient
cardiovascular diseases
Prospective Studies
education
education.field_of_study
business.industry
Cardiogenic shock
Percutaneous coronary intervention
General Medicine
Middle Aged
medicine.disease
Treatment Outcome
Cardiology
Female
Stents
Cardiology and Cardiovascular Medicine
business
Subjects
Details
- ISSN :
- 20488734
- Volume :
- 3
- Issue :
- 4
- Database :
- OpenAIRE
- Journal :
- European heart journal. Acute cardiovascular care
- Accession number :
- edsair.doi.dedup.....f790ca87368440ada2c78c40a3645987