Incidence, predictors, and outcomes of failed primary percutaneous coronary intervention: A 10-year contemporary experience

Amos Levi, Ran Kornowski, Muthiah Vaduganathan, Alon Eisen, Hana Vaknin-Assa, Salma Abu-Foul, Eli I. Lev, David Brosh, Tamir Bental, Abid R. Assali

Research output: Contribution to journalArticlepeer-review

10 Scopus citations

Abstract

BACKGROUND: Limited contemporary data exist regarding the incidence, predictors, and outcomes of failure of primary percutaneous coronary intervention (PCI) in the treatment of ST-segment elevation myocardial infarction (STEMI). MATERIALS AND METHODS: In this registry-based retrospective cohort study, all consecutive unselected patients (n=1725) who were hospitalized for STEMI and underwent primary PCI from January 2001 to December 2010 were included. PCI failure was defined as a final diameter stenosis greater than 30% or postdilatation Thrombolysis in Myocardial Infarction (TIMI) flow grade of 2 or less. We examined the predictors and survival among patients who failed primary PCI. RESULTS: The overall PCI failure rate was 5.4% (94 of 1725 procedures). After adjusting for prespecified baseline characteristics, independent predictors of PCI failure included age greater than 65 years (P=0.02), procedure date between 2001 and 2005 (P=0.05), night-time PCI (P=0.008), calcific lesion (P=0.008), and lower preprocedural TIMI flow grade (P=0.006). Failed PCI was associated with a 1-year mortality rate of 22% as compared with 4.2% in the successful PCI group (P<0.001). Conservative medical management was preferred in the majority of patients with failed PCI (n=78, 83%). Patients who underwent emergent surgery (n=11), conservative management (n=78), and redo PCI (n=5) experienced 30-day mortality rates of 27, 16, and 0%, respectively. CONCLUSION: Primary PCI failure in the setting of STEMI is not rare. It is associated with high-risk patient-related and angiographic-related characteristics. Primary PCI failure is associated with early and late mortality.

Original languageEnglish
Pages (from-to)145-151
Number of pages7
JournalCoronary Artery Disease
Volume25
Issue number2
DOIs
StatePublished - 1 Mar 2014
Externally publishedYes

Keywords

  • acute myocardial infarction
  • angioplasty
  • primary percutaneous coronary intervention

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