In-hospital percutaneous coronary intervention improves in-hospital survival in patients with acute inferior MI

C.G. Owens, A.J.J. McClelland, S.J. Walsh, B.A. Smith, Michael Stevenson, M.M. Khan, Aa Jennifer Adgey

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Abstract

Objective. Assess the interaction between fibrinolysis and in-hospital percutaneous coronary intervention (PCI) in patients with inferior myocardial infarction (MI), particularly those with electrocardiographic evidence of right ventricular infarction (RVI). Design. Retrospective observational study. Patients. Consecutive patients with inferior MI identified from an MI registry between January 1998 and January 2004. Interventions. Propensity analyses and multiple regression analysis were used to determine the mortality benefit of PCI. Main outcome measures. In-hospital morbidity and mortality. Results. In total, 465 patients with inferior MI received fibrinolytic therapy (median pain-to-needle time of 167 minutes; IQR 100–311 minutes). The main predictors of PCI were recurrent chest pain, peak creatine kinase, age, reinfarction, presence of heart failure and male gender. Significant independent predictors of in-hospital mortality were age ≥ 75 years, RVI, initial systolic blood pressure ≤ 80 mmHg, female gender and no in-hospital PCI. In-hospital PCI was performed in 184/465 (40%) patients; 55 (30%) had rescue PCI performed ≤ 6 hours post fibrinolysis, 45 (24%) within 6–24 hours and 84 (46%) ≥ 24 hours. In-hospital PCI was associated with reduced in-hospital mortality (PCI: 9 [5%] vs. no PCI: 40 [14 %]; p Conclusion. A strategy of timely fibrinolysis combined with in-hospital PCI including rescue PCI may result in a significant reduction in in-hospital mortality and morbidity in patients with inferior MI, particularly those with RVI.
Original languageEnglish
Pages (from-to)40-44
Number of pages5
JournalJournal of Invasive Cardiology
Volume21
Publication statusPublished - 01 Feb 2009

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