Clinical outcomes in patients with acute myocardial infarction treated with primary percutaneous coronary intervention stratified according to duration of pain-to-balloon time and type of myocardial infarction.

BACKGROUND: Based on the clinical outcomes of patients with ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI), treated with primary percutaneous coronary intervention (pPCI), this study intended to assess mortality and major adverse cardiac and cerebrovascular event (MACCE) rates according to duration of pain-to-balloon (PTB) time and type of MI. METHODS: This is a retrospective cohort study based on the prospectively collected ORPKI registry which covers PCIs performed in Poland chosen between January 2014 and December 2017. Under assessment were 1,994 STEMI and 923 NSTEMI patients. Study endpoints included mortality and MACCE rates (in-hospital, 30-day, 12- and 36-month). Predictors of all-cause mortality in the overall group, STEMI and NSTEMI were assessed by multivariable analysis. RESULTS: Kaplan-Meier survival curve analysis did not reveal significant differences between the STEMI and NSTEMI group for all-cause mortality or MACCE at the 36-month follow-up. While in the long PTB time group, MACCE rate was significantly greater in STEMI patients when compared to NSTEMI (p = 0.004). Among STEMI patients, the short, medium and long PTB time groups differed significantly in the rate of all-cause mortality (p = 0.006) and MACCE (p = 0.04) at 1,095 days of follow-up, which were the greatest in the long PTB time group. CONCLUSIONS: Before considering the length of PTB time, there were no statistically significant differences in mortality or MACCE frequency between the STEMI and NSTEMI group at 36-month follow-up. Longer PTB times are related to significantly greater mortality at the 36-month follow-up in the STEMI, but not in the NSTEMI group.

Frequency and predictors of diagnostic coronary angiography and percutaneous coronary intervention related to stroke.

BACKGROUND: Stroke related to percutaneous coronary interventions (PCIs) is an infrequent complication, which can be potentially life-threatening and can lead to serious disability. AIMS: This study aimed to assess the relationship between the type of coronary procedure and incidence of stroke, as well as its predictors. METHODS: This retrospective analysis was performed on prospectively collected data gathered in the Polish National Registry of Percutaneous Coronary Interventions (ORPKI) between January 2014 and December 2019 and included 1177 161 coronary procedures. Among them, 650 674 patients underwent isolated diagnostic coronary angiography (DCA), and 526 487 PCI. Stroke was diagnosed in 157 patients (0.013%), of which 100 (0.015%) happened during DCA and 57 (0.011%) during PCI. Multivariable logistic regression analysis was performed to separate predictors of stroke in patients undergoing coronary angiography and PCI. RESULTS: The percentage of patients with periprocedural stroke was higher in the group treated with isolated DCA during the analyzed time. Among predictors of stroke in patients undergoing DCA, we confirmed prior stroke (P <0.001), contrast amount (P = 0.007), femoral access (P = 0.002), unfractionated heparin use (P = 0.01), direct transport to the catheterization laboratory (P = 0.04), older age (P <0.001) and multi-vessel disease (P <0.001). While for PCI ± DCA, these were prior stroke (P <0.001), thrombolysis (P = 0.003), treatment with bivalirudin (P <0.001), and acetylsalicylic acid loading during PCI (P = 0.003). CONCLUSIONS: Based on the large national registry, PCI ± DCA is associated with fewer risk factors and a lower rate of periprocedural strokes than isolated DCA.