In-hospital and one-year outcomes for patients undergoing percutaneous coronary intervention for acute myocardial infarction

doi:10.1016/S0002-9149(02)02656-5

The American Journal of Cardiology

Volume 90, Issue 9, 1 November 2002, Pages 932-936

https://doi.org/10.1016/S0002-9149(02)02656-5 Get rights and content

Abstract

Previous studies have identified risk factors for short- and long-term outcomes for patients undergoing percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI). However, it remains unknown whether they can be generalized to current PCI practice for a broader cohort of patients. We analyzed the follow-up information (mortality and revascularization procedures) obtained from a nationwide Japanese registry during 1997 of a total of 2,211 patients with AMI who underwent PCI at 143 facilities. Demographic, clinical, angiographic, and procedural variables were submitted to statistical analysis to detect the risk factors of adverse outcomes. In-hospital and 1-year mortality rates were 7.1% and 10.9%, respectively. The most important risk factor for in-hospital death was attempted PCI of the left main (LM) coronary artery. Further independent risk factors for death were left ventricular (LV) dysfunction (ejection fraction ≤40%), LM disease, older age, multivessel disease, cerebrovascular disease, and diabetes. The receiver-operating characteristics curve for the predicted probability of death was 0.88, indicating a good ability to discriminate high-risk patients. Independent risk factors for 1-year postdischarge mortality were LV dysfunction, older age, renal failure, multivessel disease, and diabetes. The incidence of the need for repeat PCI or bypass surgery was significantly higher in patients with multivessel and LM disease. PCI is a valuable treatment strategy for a broad spectrum of patients with AMI. However, the mortality for patients with LM disease and poor LV function is still high even using current practice standards.

Section snippets

Patient population:

Patient selection and data collection have been previously described.3 Briefly, the JCIS survey demonstrated that 109,788 PCI procedures were performed at 1,023 laboratories during 1997 in Japan. Patient characteristics and outcomes were evaluated from a total of randomly selected 10,642 PCIs, which represented approximately 10% of all PCIs registered in the JCIS. All patients with AMI (n = 2,540) who had undergone PCI were identified. Inclusion criteria were patients with AMI who presented

Baseline characteristics:

Patient characteristics are listed in Table 1. A large proportion of cases (60%) had single-vessel disease, 37% had multivessel disease, and 2% had LM disease. The most common coronary risk factor was smoking, followed by hypertension, hypercholesterolemia, and diabetes mellitus. The most common segment in which PCI was attempted was in the left anterior descending coronary artery (51%), followed by right coronary artery, left circumflex coronary artery, or bypass graft.

In-hospital mortality:

The overall

Discussion

The in-hospital and 1-year outcomes were assessed in a cohort of 2,211 patients with AMI who underwent PCI and who had diverse clinical characteristics. In-hospital mortality was increased in patients with attempted PCI of LM disease, LV dysfunction (LV ejection fraction ≤40%), LM disease, multivessel disease, older age, cerebrovascular disease, and diabetes. One-year postdischarge mortality was increased in patients with LV dysfunction, older age, renal failure, multivessel disease, and

Acknowledgements

This survey could not have been carried out without the help, cooperation, and support of the cardiologists and cardiac surgeons in the survey institutions. We thank the participating cardiologists and cardiac surgeons for allowing us to obtain the data.

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^☆: This study was supported by Health Sciences Research Grants (Research on Health Services) from the Japanese Ministry of Health, Labour and Welfare (#10150305), Tokyo; and Japan Arteriosclerosis Prevention Fund, Tokyo, Japan.

^*: The investigators of the study group are listed in the Appendix.

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Regular paperIn-hospital and one-year outcomes for patients undergoing percutaneous coronary intervention for acute myocardial infarction☆

Abstract

Section snippets

Patient population:

Baseline characteristics:

In-hospital mortality:

Discussion

Acknowledgements

J Am Coll Cardiol

J Am Coll Cardiol

J Am Coll Cardiol

Am J Cardiol

J Am Coll Cardiol

J Am Coll Cardiol

Am J Cardiol

J Am Coll Cardiol

Regular paper
In-hospital and one-year outcomes for patients undergoing percutaneous coronary intervention for acute myocardial infarction☆