CCC 2011: STEMI Heart Attack and Safety

December 2011

Dr. Michel Le May

Dr. Michel Le May, Director of the Heart Institute Regional STEMI Program, discussed the impact of bleeding on mortality in patients referred to primary percutaneous coronary intervention (PCI; angioplasty and stenting) through the STEMI heart attack program.

Patients who had a major or minor bleeding event during PCI tended to be older, female, and have a history of hypertension or kidney problems. Other factors predictive of bleeding included a longer door-to-balloon time, disease in more than one blood vessel, warfarin taken at time of admission, and warfarin prescribed at discharge.

Patients who bled had significantly higher mortality in hospital and at 30 and 180 days after discharge. These patients also had a higher rate of subsequent heart attack, stroke, shock and blood clots associated with a stent. Dr. Le May concluded that altering some of the identified factors could lead to fewer bleeding events and better clinical outcomes.

Dr. Christopher Glover
Dr. Christopher Glover

Dr. Christopher Glover, an interventional cardiologist, examined the relationship of cardiogenic shock and mortality after STEMI, as well as risk factors for the complication, within the Heart Institute’s regional STEMI protocol.

The researchers looked at all patients referred to primary PCI from 2004 to 2009. Patients who developed shock were older, had a history of hypertension or diabetes, and were more likely to have had a previous heart attack.

Findings support the need for continued improvements in door-to-balloon times and for identifying patients with or at risk for cardiogenic shock.

Patients transported to the Heart Institute by ambulance were also more likely to develop shock—an unexpected finding—and most patients with cardiogenic shock were already in that condition by the time they reached the Institute.

Mortality was low overall in all patients: 5 per cent after the primary intervention and 8 per cent 180 days later. However, the small subset with cardiogenic shock had 43 per cent mortality in hospital and 47 per cent by six months after treatment. The findings support the need for continued improvements in door-to-balloon times and for identifying patients with or at risk for cardiogenic shock.

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