J Transcat Intervent.2018;26(1-2):eA0007.

Original Article

Rescue percutaneous coronary intervention: analysis of a Brazilian registry

Júlio Cesar Schulz, Guy Fernando de Almeida Prado, Charles Luiz Vieira, Siegmar Starke, Humberto Bolognani Tridapalli, Marisete de Fatima de Almeida, Marcelo José de Carvalho Cantarelli

DOI: 10.31160/JOTCI2018;26(1)A0007

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ABSTRACT

Background

Rescue percutaneous coronary intervention is indicated after failed fibrinolysis in patients with ST-segment elevation myocardial infarction. The objective was to determine the profile of Brazilian patients in this context and their in-hospital outcomes.

Methods

We prospectively collected data on 1,334 patients submitted to rescue percutaneous coronary intervention registered at the Central Nacional de Intervenções Cardiovasculares (CENIC). Patients were divided into three tertiles of time: 2006-2008, 2009-2011, and 2012-2016. The primary composite endpoint was the rate of major adverse cardiac events: death, acute myocardial infarction, or emergency myocardial revascularization.

Results

Of the 1,334 patients, 71.1% were male, mean age of 59.7±11.8 years. Decreased prevalence of hypertension (p=0.0006), dyslipidemia (p=0.01), and diabetes mellitus (p=0.02) was observed throughout the tertiles, as well as an increased number of cases classified as Killip 1 (p<0.0001). Regarding characteristics of angiography and procedure, there was a progressive decrease in thrombotic lesions (p<0.0001), occlusions (p=0.003), and use of glycoprotein IIb/IIIa inhibitors (p>0.0001). There was also an increase in use of drug-eluting stents (p<0.0001), as well as in the success of the procedure (p=0.03). The rate of major adverse cardiac events was low, with a tendency to decrease in the last tertile (5.2% vs. 6.3% vs. 2.2%; p=0.06). In total, acute myocardial infarction and death rates were 1.1% and 4.3%, respectively.

Conclusions

The low rate of major adverse cardiac events demonstrated the efficacy and safety of rescue percutaneous coronary intervention in Brazil. The current improvement of indicators may be associated with changes in the clinical profile, better devices, and adoption of protocols.