Primary percutaneous coronary intervention in the Isfahan province, Iran; A situation analysis and needs assessment

Abstract

BACKGROUND: Primary percutaneous coronary intervention (PPCI) is considered as a choice of treatment in ST-elevation myocardial infarction (STEMI). PPCI has been performed in the Isfahan Province for several years. This study was performed to describe the situation, and determine in-hospital and early (30 days) clinical outcomes of the patients in order to provide sufficient evidence to evaluate and modify this treatment modality if necessary. METHODS: All patients, who underwent PPCI for STEMI from July to December 2011 at Chamran and Saadi Hospitals (PPCI centers in the Isfahan Province), were included in this case series study. Premedication, angioplasty procedure, and post-procedural treatment were performed using standard protocols or techniques. All discharged patients were followed for 30 days by phone. Endpoints consisted of clinical success rate, and in-hospital and 30 day major adverse cardiac events (MACEs) (death, reinfarction, stroke, and target vessel revascularization). RESULTS: 93 patients (83 (89.2%) at Chamran Hospital and 10 (10.8%) patients at Saadi Hospital) had PPCI. Mean Age of the patients was 59.60 ± 11.10 and M/F ratio was 3.89. From the 181 involved vessels (involved vessels/patient ratio = 1.97 ± 0.70), the treatment of 105 lesions (lesions/patient ratio = 1.13 ± 0.368) was attempted. The clinical success rate was 72%. Pain-to-door and door-to-balloon times were, respectively, 255.1 ± 221.4 and 148.9 ± 168.5 min. The reason for failure was impaired flow (n = 17 (18.3%)), failure to cross with a guidewire (n = 2 (2.2%)), suboptimal angiographic results (n = 2 (2.2%)), and death in one patient. The in-hospital and 30 days MACE rates were, respectively, 8.6% and 3.2%. CONCLUSION: Low success rate in our series could be due to prolonged pain-to-door and door-to-balloon times and lack of an established, definite protocol to regularly perform PPCI in a timely fashion. We should resolve these problems and improve our techniques in order to prevent and treat slow/no-reflow phenomenon.   Keywords: Acute Coronary Syndrome, Myocardial Infarction, Percutaneous Transluminal Coronary Angioplasty, Cardiogenic Shock, No-Reflow Phenomenon