An Overview of Care Changes in the Last 6 Year in Primary PCI in ST-Elevation Myocardial Infarction in a Tertiary University Brazilian Hospital

Abstract Background: Although new studies and guidelines can be considered useful tools, it does not necessarily mean they are put into clinical practice. Objective: The aim of the current analysis was to assess the changes in primary percutaneous coronary intervention (PCI) and mortality in a tertiary university hospital in southern Brazil during a six-year period. Methods: We have included consecutive patients with ST-elevation myocardial infarction (STEMI) who underwent primary PCI between March 2011 and February 2017. Previous clinical history, characteristics of the procedure, and reperfusion strategies were collected. In-hospital, short and long-term mortalities were also evaluated. The significance level adopted for all tests was 5%. Results: There was an increase in the use of radial access in patients from 20.0% in 2011 to 62.7% in 2016 (ptrend < 0.0001). Moreover, thrombus aspiration decreased significantly from 66.7% in 2011 to less than 3.0% in 2016 (ptrend < 0.0001). In-hospital, short and long-term mortalities remained reasonably stable from 2011 to 2016 (ptrend > 0.05). However, a lower in-hospital mortality was observed in patients treated through radial access (p < 0.001). Cardiogenic shock occurred in 11.1%, without statistical differences in the period (ptrend = 0.39), while long-term mortality rate decreased from 80.0% in 2011 to 27.3% in 2016 in this patient group (ptrend = 0.29). Conclusions: During a 6-year follow-up period, primary PCI characteristics underwent important modifications. Radial access became widely used, with a decrease in mortality with the use of this route, while aspiration thrombectomy became a rare procedure. The incidence of cardiogenic shock remained stable, but has shown a reduction in its mortality.

摘要 背景：尽管新的研究与指南可被视为实用工具，但这并不意味着它们能顺利应用于临床实践。
目的：本分析旨在评估巴西南部一所三级大学附属医院六年间，首次经皮冠状动脉介入治疗（primary percutaneous coronary intervention, PCI）的应用变化与患者死亡率情况。
方法：本研究纳入2011年3月至2017年2月期间接受首次PCI的ST段抬高型心肌梗死（ST-elevation myocardial infarction, STEMI）连续患者。收集患者既往病史、手术特征及再灌注策略相关数据，并对院内、短期及长期死亡率进行评估。所有检验采用的显著性水平均为5%。
结果：经桡动脉入路的患者占比从2011年的20.0%升至2016年的62.7%（趋势检验ptrend < 0.0001）。此外，血栓抽吸术的应用占比从2011年的66.7%显著降至2016年的3.0%以下（ptrend < 0.0001）。2011年至2016年间，患者院内、短期及长期死亡率均保持相对稳定（ptrend > 0.05）。但经桡动脉入路治疗的患者院内死亡率更低（p < 0.001）。心源性休克发生率为11.1%，各年间无统计学差异（ptrend = 0.39）；而该亚组患者的长期死亡率从2011年的80.0%降至2016年的27.3%（ptrend = 0.29）。
结论：在为期六年的随访周期内，首次PCI的临床应用特征发生了显著变化。经桡动脉入路得到广泛普及，且该入路可降低患者死亡率；而血栓抽吸术已逐渐成为罕见操作。心源性休克的发生率保持稳定，但其相关死亡率呈下降趋势。