Evolving trends in procedural characteristics and clinical Ooutcomes in patients undergoing percutaneous coronary intervention (PCI) for ST-elevation myocardial Infarction (STEMI).

Abstract

Background: Over the last decade, STEMI systems of care have evolved to improve timely access to PCI. There have also been advances in PCI technique and adjunctive pharmacotherapy. We sought to determine temporal changes in practices and clinical outcomes of PCI in STEMI patients.

Method: We prospectively collected data on 8412 consecutive patients undergoing STEMI PCI between 2005 and 2016 in the multi-centre Melbourne Interventional Group registry. Data were divided by procedure year for trends analysis. The primary endpoint was 30-day mortality.

Results: Patient demographics and comorbidities like smoking and diabetes have remained stable over time. The volume of primary PCI has significantly risen (65.7% to 80.1%, p < 0.01) with a concurrent fall in post-thrombolysis PCI (22.0% to 12.1%, p < 0.01). The proportion of patients achieving a door-to-balloon time ≤90 minutes has risen (37.6% to 59.0%, p < 0.01). More STEMI patients post out-of-hospital cardiac arrest or with Killip class 3-4 are now being treated with PCI. A shift from mainly femoral to radial access and from bare-metal to drug-eluting stent use was seen. Glycoprotein IIb/IIIa inhibitors are being used less frequently with increasing use of newer antiplatelet agents. Thirty-day mortality has remained low throughout the period at 6.5% overall (p for trend = 0.09).

Conclusion: Despite increasing patient acuity, mortality rates have remained low for patients undergoing STEMI PCI. Timely access to primary PCI has improved likely due to better availability of 24-hour PCI and more streamlined STEMI care pathways. Preferred vascular access route, stent type and adjunctive pharmacotherapy have evolved over the last decade.