Experience of primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction at a referral healthcare centre in India

Background. India has the highest burden of coronary artery disease in the world. It also has a higher rate of ST-segment elevation myocardial infarction than that in developed countries. Primary percutaneous coronary intervention is an effective treatment, yet little is known about its feasibility and outcome in India. We studied the outcomes of primary percutaneous coronary intervention at an Indian tertiary care centre. Methods. We did a prospective observational study of 1000 consecutive patients with ST-segment elevation myocardial infarction, who were treated with primary percutaneous coronary intervention from December 2010 to May 2014 at Sri Venkateswara Institute of Medical Sciences, Tirupati, India. Patient characteristics, procedural details, in hospital and 3-month adverse events were assessed. Results. The mean (SD) age of our patients was 54.5 (11.3) years. Among the study population, 82.9% were men, 32.8% had diabetes mellitus, and 36.3% had hypertension. Only 18.2% of the patients came to hospital in an ambulance, and 6% were in cardiogenic shock. Most frequently, the left anterior descending artery was the infarct related artery (57.9%). The mean (SD) time from onset of symptoms to arrival at hospital was 369.6 (204.6) minutes and the mean door-to-balloon time was 58.6 (17.1) minutes. The in-hospital adverse event rate was 5.7% (mortality 3.6%, non-fatal reinfarction 0.9%, stroke 0.3%, major bleeding 0.9%). Patients without cardiogenic shock had an in-hospital survival rate of 99.1%. During 3 months of follow-up, 0.9% of patients died and 0.8% had non-fatal reinfarction. The 3-month survival rate was 95.5%. Conclusion. Primary percutaneous coronary intervention is feasible in India with an acceptable door-to-balloon time and low rates of adverse events despite longer time to presentation.