Evaluation of the percutaneous coronary intervention as a diagnostic or therapeutic tool in 501 consecutive cases of acute coronary syndrome

Objective

The evaluation of the percutaneous coronary intervention (PCI) as a diagnostic or therapeutic tool in patients with acute coronary syndrome (ACS) admitted to an ICU.

Materials and methods

From October 2003 to December 2006, 501 patients with ACS were admitted to the ICU. The data collection was made prospectively using interviews with patients, chart reviews and examinations. The follow-up was made 6 months after the coronary event for evaluation of later death and new hospital admission (351 patients) using telephone calls. Statistical analysis was performed with the chi-square test.

Results

A total of 419 patients with ACS were submitted to PCI. In this group, 124 patients (29.5%) had unstable angina, 112 (26.7%) had non-ST-segment elevation myocardial infarction and 183 (43.6%) had ST-segment elevation myocardial infarction. The mean age was 62.43 years old (27–95 years) and 71.1% were men. The diagnostic PCI was made in 234 patients (55.9%) and the therapeutic in 185 patients (44.1%). One hundred and four patients (56.2%) received a nonpharmacological stent and 73 patients (39.4%) received a pharmacological stent. The most affected arteries were the anterior descending (58.2%), right coronary (44.8%), and circumflex (24.8%). Seventy-six patients were submitted to coronary artery bypass graft after PCI. Hospital mortality was 6.2%, corresponding to 5.5% of diagnostic PCI and 7.0% of the angioplasty group (P = 0.54). Follow-up was made with 304 or 86.6% of the patients at least 6 months after the initial hospitalization. The mean time of follow-up was 12.68 months (6–31 months). The later mortality was 2.3%, corresponding to 3.4% of diagnostic PCI and 0.7% from the angioplasty group (P = 0.14). There were 33 (19.4%) new hospital admissions for cardiac causes in the diagnostic group and 29 (21.9%) in the angioplasty group (P = 0.56).

Conclusion

There were no significant differences in mortality between diagnostic and therapeutic PCI.