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Long-term prognosis after primary PCI in unselected patients with ST-elevation myocardial infarction.
MedLine Citation:
PMID:  22772599     Owner:  NLM     Status:  Publisher    
AIMS: Long-term prognosis of ST segment elevation myocardial infarction (STEMI) in the era of primary percutaneous coronary intervention (pPCI) remains relatively poorly investigated in unselected patients. This study analyzed 8-year follow-up of STEMI patients enrolled in the Florence Acute Myocardial Infarction Registry, a population-based, observational study performed in Italy in 2000-2001. METHODS: The prognostic effect of pPCI adjusted for clinical and demographic characteristics on a composite end-point of new myocardial infraction, urgent revascularization or death, and on all-cause mortality separately, was assessed in multivariable Cox analysis, calculating hazard ratios and 95% confidence intervals. This analysis is concerned with 875 STEMI patients (mean age 70.6 ± 12.9 years), treated with pPCI (459) or conservatively (416). RESULTS: After 8 years, 59% of patients had experienced the composite end-point and 49% had died. The multivariable analysis showed a significantly better prognosis in patients receiving pPCI (hazard ratio 0.72, P = 0.001), evident also in the 645 patients who were event-free after the first year of follow-up (hazard ratio 0.72, P = 0.010). Other independent prognostic factors were advanced age, Killip class greater than 1, some cardiovascular or noncardiovascular comorbidities, in-hospital cardiogenic shock, ejection fraction less than 30%, and treatment with aspirin and statin during hospitalization. The beneficial effect of pPCI observed both in cases younger (adjusted hazard ratio 0.65, P = 0.013) and older than 75 years (adjusted hazard ratio 0.65, P = 0.001) was also confirmed considering as outcome all-cause mortality only. CONCLUSIONS: In unselected STEMI patients, survival advantage from pPCI extends for a long term (8 years). This survival advantage is maintained at advanced ages, thus enforcing the importance of improving delivery of appropriate care to older STEMI patients.
Alessandro Barchielli; Giovanni M Santoro; Daniela Balzi; Nazario Carrabba; Mauro Di Bari; Gian Franco Gensini; Maurizio Filice; Cristina M Landini; Serafina Valente; Alfredo Zuppiroli; Niccolò Marchionni
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-7-5
Journal Detail:
Title:  Journal of cardiovascular medicine (Hagerstown, Md.)     Volume:  -     ISSN:  1558-2035     ISO Abbreviation:  -     Publication Date:  2012 Jul 
Date Detail:
Created Date:  2012-7-9     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101259752     Medline TA:  J Cardiovasc Med (Hagerstown)     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
aEpidemiology Unit, Local Health Unit 10 - Firenze, Florence, Italy bCardiology Unit, Nuovo San Giovanni di Dio Hospital, Local Health Unit 10 - Firenze, Florence, Italy cCardiology Unit 1, Department of Cardiovascular Medicine, Careggi Hospital, Florence Italy dUnit of Gerontology and Geriatric Medicine, Department of Cardiovascular Medicine, University of Florence and Careggi Hospital, Florence, Italy eUnit of Internal Medicine and Cardiology, Department of Cardiovascular Medicine, University of Florence and Careggi Hospital, Florence, Italy fCardiology Unit, Santa Maria Nuova Hospital, Local Health Unit 10 - Firenze, Florence, Italy gCardiology Department, Local Health Unit 10 - Firenze, Florence, Italy hEpidemiology Unit, Regional Agency of Public Health of Tuscany, Florence, Italy.
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