Primary PCI for STEMI Patients: Has Patients Access and Hospital Outcome Improved over the Last 5 Years

Abstract

Mohammed Balghith, Amir Salih, Kamal Ayoub, Ali Alghamdi, Gaida Albargy, Feras Asiri, Basil Saeed

Background: Reperfusion therapy by Primary PCI in ST-segment elevation myocardial infarction (STEMI result in great benefit than from fibrin lytic therapy, The fast access to PPCI will improve hospital outcome, We believe that patient access to PPCI facility would have improved due to improved public awareness and expanding evidenced-based health provision.

Method: This is a retrospective study to analyze and compare data for STEMI patients during 2010 (Group l = 223 pts) and those treated between August 2014 and August 2015 (Group 2 = 288 pts). We compared demographic and baseline characteristics, patient’s access, reason for no access and hospital mortality for the two groups.

Results: Among the 288 patients in G2, 247 patients (85%) were males with average age of 57 yrs. 49% were diabetics, 48% hypertensive, 48% were smokers and 27% were obese. These were not different in G1. Of G2, 164 pts (57%) only had access to PPCI compared to 56% in G1 (p = 0.536-NS). In G2, the main reasons for no PPCI was late presentation in 47% vs 53% in G1; P = 0.34-NS and 27% due to thrombolysis vs 17% in G1 (p = 0.11NS). Hospital mortality in G2 was 4% in those treated with PPCI compared to 2.3% in Gi (P = 0.522-NS). Mortality In pts who did not receive PPCI in G2 was 8% compared to 11.3% in G1 (p = 0.49-NS). Females in G2 have about 3 times higher mortality. Compared to 2010, pts treated for STEMI in the last 12 months at KACC still have same, relatively low access to pPCI due mainly to persistent pattern of late presentation and prior thrombolysis which reflect apparent lack of direct access to hospitals with PPCI facilities.

Conclusion: Comparing the two periods there was no change in the practice, the low access to PPCI was mainly due to late presentation and Prior thrombolysis, Hospital mortality rate for patients treated with PPCI remained low during the two eras, this seemingly relates to both lack of public awareness and health provision factors in PPCI organizations.

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