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.