Background: Percutaneous coronary intervention (PCI) has been proven to be the gold standard of reperfusion therapies in acute ST-elevation myocardial infarction (STEMI) in the western world. Highly trained teams and good logistical management of cathlabs may be limiting factors in developing countries and data about outcomes following PCI in such areas is scarce.
Aim: The objectives of this study were to describe the procedural and clinical outcomes of patients undergoing PCI for STEMI at a university hospital in Tunisia and make a comparison with outcomes from the West.
Methods: We conducted a retrospective cohort study at a tertiary care university hospital in Tunis, Tunisia. A total of 208 consecutive patients undergoing PCI between January 2005 and June 2007 were reviewed. Univariate, multivariate and Kaplan meier analyses were constructed. The primary outcome was mortality: in-hospital, 30 days, and 12 months later.
Results: Cardiovascular risk factors were mainly smoking (63%) and diabetes (35.1%). The mean patient's TIMI score was 3.8+0.2 (10% were in cardiogenic shok). Procedural success was 75.5%. In-hospital, 30 days and 12-month mortality were respectively 5.3%, 6.7% and 8.2%, comparing favorably with TIMI's score predicted mortality and the published registries from developed countries. Multivariate predictors of in-hospital death included age >70 years, mutivessel disease and PCI failure. Multivariate predictors of 12-month death were killip score >2 at admission (odds ratio = 2.1) and PCI failure (odds ratio = 2.9).
Conclusion: We conclude that, despite the logistical difficulties, excellent outcomes for acute interventional reperfusion strategy in STEMI can be achieved in a developing country, possibly similar to those seen in the West. There is a strong need for making the practice of PCI in STEMI more widespread in developing regions.