Predictors of Success and Major Complications for Primary Percutaneous Transluminal Coronary Angioplasty in Acute Myocardial Infarction

Abstract

The rates of success and major complications in the SCA&I Registry are similar to other series. Predictors of success and major complications can be assessed and may be useful for risk stratifying candidates for primary angioplasty in acute MI.

Volume-Outcome Relation for Physicians and Hospitals Performing Angioplasty for Acute Myocardial Infarction in New York State

“…18,19 The 2 largest studies, involving Ͼ284 000 patients, however, have demonstrated a significant relation between hospital primary angioplasty volume and mortality. 13,17 The results of these studies, in combination with the linear nature of the hospital volume-outcome relation demonstrated in the present study, strongly suggest that hospital primary angioplasty volume is at least a partial surrogate for the process of care, with higher-volume hospitals having systems and protocols in place that minimize delays in restoration of coronary blood flow.…”

“…This definition of primary angioplasty is consistent with that used by the Second National Registry of Myocardial Infarction 17 and the Society of Cardiac Angiography and Interventions. 18 To eliminate patients undergoing PTCA after unsuccessful thrombolysis (rescue angioplasty), we excluded those who had received thrombolytic therapy within 7 days before the procedure.…”

Sex-Based Differences in Early Mortality of Patients Undergoing Primary Angioplasty for First Acute Myocardial Infarction

“…This definition of primary PTCA is consistent with that used by the Society of Cardiac Angiography and Interventions. 35 We excluded patients with a prior AMI to examine the biological response to AMI in a population experiencing first AMI. We also excluded patients who had been treated with thrombolytic therapy within the previous 7 days or those with prior open-heart surgery.…”

ACC/AHA/SCAI Practice Guidelines, February 21, 2006

“…Reported rates for death after diagnostic catheterization range from 0.08% to 0.14%, whereas analyses of large registries indicate overall unadjusted in-hospital rates for PCI of 0.4% to 1.9% (Table 3) (41)(42)(43)(44)(45)(46)(47)(48)(49)(50)(51)(52). This range is greatly influenced by the clinical indication for which PCI is performed, with the highest mortality rates occurring among patients with STEMI and cardiogenic shock.…”

“…The certification should also include whether the candidate has achieved requisite competence in related interven- Other studies have also supported the relationship of complication rate to procedural volume (47,306,314). Although some investigators have suggested that low procedure volume does not contribute to poor outcomes (44,309), these studies are small in number and underpowered for analysis (318).…”