engleski

Primary coronary intervention in University hospital “Sestre milosrdnice”, Zagreb, Croatia: What Hve we learned after more than 6 years?

INTRODUCTION: Primary coronary intervention (PCI) is the most effective reperfusion strategy in the tratment of the patients (pts) with acute myocardial infarction with ST elevation (STEMI). This strategy was introduced as 24 hours service of experienced team of interventional cardiologists in University hospital "Sestre milosrdnice" and in Croatia in October 1st 2000. MATERIAL AND METHODS: From October 1 st until February 17 th 2006. primary PCI was performed in 601 pts with acute STEMI within first 12 hours of the onset of symptoms. 437 of the patients (72%) were male with average age of 59 years and 164 (28%) were female with average years of 66 years. RESULTS: In 75 pts (13%) only PTCA was performed, in 464 pts (77%) PTCA was followed by STENT implantation or primary stenting without primary PTCA was performed, while in 62 pts (10%) procedure was unsuccessful. Right coronary artery (RCA) was found as culprit lesion in 272 pts (45%), left descending artery (LAD) in 224 pts (37%), circumflex artery (ACx) in 68 pts (11%) and left main artery in 4 pts (0, 7%). In other patients culprit lesion was in minor branches or combination. The average time from the beginig of symptoms was 189 minutes, and average "door-to-balloon" time was 81 minutes. Among 601 investigated pts 60 (10%) developed cardiogenic shock. Despite interventional therapy 36 pts died during hospitalisation. Most of those patients (72%) died during first 48 hours, higher mortality rate was in female pts (9.1%) than in male pts (4.8%), they were on average older (67 years) than whole group of investigated patients. Higher mortality rate was also found in pts with culprit lesion in left man (50%) and LAD (8, 4%), then in RCA or ACx (4, 4% respectivly), in those with unsuccesfull PCI (14.5%) and only PTCA (12%) then in those with STENT implantation (3, 9%), as well as in pts with affected right ventricle (13.4%) and STEMI of anteroseptal wall (12.6%). Cardiogenic shock was associated with mortality rate of 36%. The time from the begining of the symptoms and "door-to-baloon" time did not influenced mortality rate. CONCLUSIONS: Primary PCI ensures the best chances for recovery and survival of patients with acute STEMI. Unfavourable factors in risk stratifications are higher age, female sex, cardiogenic shock, culprit lesion in left main and LAD, affection of right ventricle or anterosptal wall and unsuccessful PCI or performance of only PTCA.

STEMI; PRIMARY PERCUTANEOUS CORONARY INTERVENTION

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