Primary percutaneous coronary intervention in the Isfahan province, Iran; A situation analysis and needs assessment

BACKGROUND: Primary percutaneous coronary intervention (PPCI) is considered as a choice of treatment in ST-elevation myocardial infarction (STEMI). PPCI has been performed in the Isfahan Province for several years. This study was performed to describe the situation, and determine in-hospital and early (۳۰ days) clinical outcomes of the patients in order to provide sufficient evidence to evaluate and modify this treatment modality if necessary. METHODS: All patients, who underwent PPCI for STEMI from July to December ۲۰۱۱ at Chamran and Saadi Hospitals (PPCI centers in the Isfahan Province), were included in this case series study. Premedication, angioplasty procedure, and post-procedural treatment were performed using standard protocols or techniques. All discharged patients were followed for ۳۰ days by phone. Endpoints consisted of clinical success rate, and in-hospital and ۳۰ day major adverse cardiac events (MACEs) (death, reinfarction, stroke, and target vessel revascularization). RESULTS: ۹۳ patients (۸۳ (۸۹.۲%) at Chamran Hospital and ۱۰ (۱۰.۸%) patients at Saadi Hospital) had PPCI. Mean Age of the patients was ۵۹.۶۰ ± ۱۱.۱۰ and M/F ratio was ۳.۸۹. From the ۱۸۱ involved vessels (involved vessels/patient ratio = ۱.۹۷ ± ۰.۷۰), the treatment of ۱۰۵ lesions (lesions/patient ratio = ۱.۱۳ ± ۰.۳۶۸) was attempted. The clinical success rate was ۷۲%. Pain-to-door and door-to-balloon times were, respectively, ۲۵۵.۱ ± ۲۲۱.۴ and ۱۴۸.۹ ± ۱۶۸.۵ min. The reason for failure was impaired flow (n = ۱۷ (۱۸.۳%)), failure to cross with a guidewire (n = ۲ (۲.۲%)), suboptimal angiographic results (n = ۲ (۲.۲%)), and death in one patient. The in-hospital and ۳۰ days MACE rates were, respectively, ۸.۶% and ۳.۲%. CONCLUSION: Low success rate in our series could be due to prolonged pain-to-door and door-to-balloon times and lack of an established, definite protocol to regularly perform PPCI in a timely fashion. We should resolve these problems and improve our techniques in order to prevent and treat slow/no-reflow phenomenon.   Keywords: Acute Coronary Syndrome, Myocardial Infarction, Percutaneous Transluminal Coronary Angioplasty, Cardiogenic Shock, No-Reflow Phenomenon