Journal of Thrombosis and Thrombolysis

, Volume 32, Issue 2, pp 223–231

Impact of primary PCI volume on hospital mortality in STEMI patients: does time-to-presentation matter?

  • Eliano Pio Navarese
  • Stefano De Servi
  • Alessandro Politi
  • Alessandro Martinoni
  • Giuseppe Musumeci
  • Enrico Boschetti
  • Guido Belli
  • Maurizio D’Urbano
  • Emanuela Piccaluga
  • Corrado Lettieri
  • Silvio Klugmann
Article

Abstract

The exact relationship between primary percutaneous coronary intervention (PCI) volume and mortality remains unclear. No data are available on how this relationship could be affected by time-to-presentation. The primary aim of this study was to evaluate the impact of hospital primary PCI volume on in-hospital mortality in ST-elevation myocardial infarction (STEMI) patients depending on time-to-presentation. The impact of primary PCI volume on in-hospital mortality was investigated in a prospective registry of the Lombardy region in Northern Italy, deriving data on mortality rates and number of primary PCIs from a cohort of 2,558 patients. We also explored this relationship at different times-to-presentation (≤90 min, >90 min–180 min, >180 min) and risk profiles assessed with the TIMI Risk Index. A strong inverse relationship was found between primary PCI hospital volume and risk-adjusted mortality (r = −0.9; P < 0.001). High primary PCI volumes best predicted the improvement of survival when the time-to-presentation was ≤90 min (area under the curve = 0.73, P < 0.0001). At this time, the best primary PCI threshold to provide benefit was >66 primary PCIs/year (OR = 0.21 [95% CI 0.10–0.47], P < 0.001) and those with high TIMI Risk Index achieved the greatest benefit (P < 0.001). At >90 min–180 min, the model was less significant (P = 0.02) with a higher threshold of procedures (>145 primary PCIs/year) required to provide benefits. The model was not predictive of survival for time-to-presentation >180 min (P = 0.30). The reduction of mortality of STEMI patients treated at high-volume primary PCI centers is time-dependent and affected by risk profile. The greatest benefit was observed in high-risk patients presenting within 90 min from symptoms onset.

Keywords

ST-elevation myocardial infarction Primary PCI Mortality Risk profile 

Abbreviations

STEMI

ST-elevation myocardial infarction

ANT MI

Anterior infarction

PCI

Percutaneous coronary intervention

TIMI

Thrombolysis in myocardial infarction

ROC

Receiving operator curve

AUC

Area under the ROC curve

AIC

Akaike information criteria

OR

Odds ratio

IC

Confidence interval

IQR

Interquartile range

NRMI

National registry of myocardial infarction

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Eliano Pio Navarese
    • 1
  • Stefano De Servi
    • 1
  • Alessandro Politi
    • 2
  • Alessandro Martinoni
    • 1
  • Giuseppe Musumeci
    • 3
  • Enrico Boschetti
    • 4
  • Guido Belli
    • 5
  • Maurizio D’Urbano
    • 1
  • Emanuela Piccaluga
    • 6
  • Corrado Lettieri
    • 7
  • Silvio Klugmann
    • 8
  1. 1.Department of Cardiovascular DiseasesAzienda Ospedaliera Ospedale Civile di LegnanoLegnano (Milan)Italy
  2. 2.Ospedale Meriggia PelaschiGravedona (Como)Italy
  3. 3.Ospedali RiunitiBergamoItaly
  4. 4.Ospedale UniversitarioTerniItaly
  5. 5.Istituto Clinico HumanitasRozzano (Milan)Italy
  6. 6.Ospedale SaccoMilanItaly
  7. 7.Ospedale Carlo PomaMantovaItaly
  8. 8.Ospedale NiguardaMilanItaly

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