P5606
Evolving trends in procedural characteristics and clinical outcomes in patients undergoing percutaneous coronary intervention for ST-elevation myocardial infarction

Extract

Background: Over the last decade, there have been many pre-hospital and in-hospital systems of care established to improve timely access to primary percutaneous coronary intervention (PCI). There have also been many advances in PCI techniques and adjunctive pharmacotherapy.

Objective: To determine changes in the practice and outcomes of PCI, in patients presenting with ST-elevation myocardial infarction (STEMI) over the last 12 years.

Methods: We prospectively collected data on 8,412 consecutive patients undergoing PCI for STEMI between 1st January 2005 and 31st December 2016 in the multi-centre Melbourne Interventional Group Registry. We divided the data according to year of PCI to analyse for trends. The primary endpoint was 30-day mortality.

Results: Patient demographics and baseline comorbidities including smoking and diabetes have remained stable over time. The volume of primary PCI within 12 hours of onset of symptoms has significantly risen over the period from 65.7% to 80.1% (p<0.001) while the volume of post-thrombolysis PCI for STEMI has concurrently fallen (22.0% to 12.1%, p<0.001). The proportion of patients with a door to balloon time (DTBT) of ≤90 minutes has increased (37.6% to 59.0%, p<0.001). Patient acuity has increased with more STEMI patients post out-of-hospital cardiac arrest (OHCA) or with Killip class 3–4 now being treated with PCI. A shift from predominant femoral to radial access and from bare-metal to drug-eluting stent use was also seen. A reduction in use of glycoprotein IIb/IIIa inhibitors and an increase in the use of newer anti-platelet agents was evident. Thirty-day mortality has remained low throughout the period at 6.5% overall (p for trend = 0.1).