Successful primary percutaneous coronary intervention determines the very long-term prognosis in ST-segment elevation myocardial infarction even in survivors of the acute phase. The ANIN Myocardial Infarction Registry

Introduction: Successful primary percutaneous coronary intervention (pPCI) saves lives in the acute phase of ST-elevation myocardial infarction (STEMI) and improves the mid-term prognosis. Whether that benefit remains significant in very long-term follow- up and is associated with total ischaemic time (TIT), especially in survivors of the acute phase of STEMI, is unknown. Aim: We sought to investigate the impact of initial and final thrombolysis in myocardial infarction (TIMI) flow on long-term survival in a homogeneous, unselected group of patients with STEMI undergoing pPCI at a high-volume centre. Material and methods: All consecutive STEMI patients treated with pPCI in our tertiary centre were enrolled in the ANIN Myocardial Infarction Registry. Results: Among 1064 patients 871 (82%) had an occluded infarct artery (IRA) at baseline, while pPCI was successful in 885 (83%) patients. At 9 years all-cause and cardiovascular (CV) mortality were 28% (294 patients) and 19% (196 patients), respectively. Failure of pPCI was an independent predictor of long-term all-cause and CV mortality (OR = 1.5, 95% CI: 1.1-2.0, p = 0.03 and OR = 1.8, 95% CI: 1.3-2.7, p = 0.001, respectively). In survivors of the acute phase, occluded IRA at baseline was an independent predictor of all-cause mortality (OR = 1.5, 95% CI: 1.0-2.3, p = 0.04), while pPCI failure predicted CV mortality (OR = 1.8, 95% CI: 1.2-2.8, p = 0.005). Mortality rate increased with TIT even in patients with pPCI success. Conclusions: Angiographic results of pPCI determine the very long-term survival of STEMI patients, even in survivors of the acute phase of STEMI. Shortening of TIT is crucial.