The impact of clinical and angiographic factors on percutaneous coronary angioplasty outcomes in patients with acute ST-elevation myocardial infarction

Introduction: Percutaneous coronary intervention (PCI) outcomes are dependent on certain clinical and angiographic factors. The impact of modifiable cardiovascular disease (CVD) risk factors on PCI outcomes is still controversial. The aim of the study was to evaluate the impact of clinical and angiographic factors on PCI outcomes for patients with acute ST-elevation myocardial infarction (STEMI).

Material and methods: Age, gender, CVD risk factors, Killip class and culprit coronary artery (CA) localization, total CA occlusion, initial and post-procedural thrombolysis in myocardial infarction (TIMI) flow grade, and thrombus aspiration characteristics were assessed retrospectively in 188 consecutive patients with STEMI who underwent primary PCI. Spearman's rho test was performed to assess hospital stay correlations, and logistic regression was applied to identify predictors of distal embolization (DE), in-hospital worsening of heart failure (WHF), and in-hospital mortality rate. Local ethics committee approval was obtained for the study.

Results: DE occurred in 12 (6.4%) patients. In-hospital WHF was diagnosed in 16 (8.5%) patients. Twelve (6.4%) patients died in hospital. Age had a positive weak correlation with hospital stay and was an independent predictor of distal embolization, in-hospital worsening of heart failure, and in-hospital mortality rate. Killip class, left main CA stenosis (> 50.0%), and post-procedural TIMI flow grade 1-2 were other predictors of death in hospital.

Conclusions: Age was an independent predictor of distal embolization, in-hospital worsening of heart failure, and in-hospital mortality. Other independent predictors of in-hospital mortality rate were Killip class, left main CA stenosis (> 50.0%), and post-procedural TIMI flow grade 1-2. The present analysis highlighted the "cholesterol paradox" with respect to in-hospital worsening of heart failure and mortality in hospital.