An increase in the number of primary percutaneous coronary intervention (PCI) procedures does not appear to have resulted in reduced mortality rates for acute myocardial infarction (AMI), according to the results of a study presented at the inaugural European Association of Percutaneous Cardiovascular Interventions (EAPCI) Summit (19–20 February, Munich, Germany).
The findings come from an analysis of data from 21 European countries, in which investigators were unable to find a significant association between the increase in primary PCI procedures and reduced mortality rates among these patients. Ali Malik (King’s College London, London, UK), who presented the findings of the study, said that statistical analyses are ongoing to evaluate the impact of primary PCI procedures across Europe.
“It is well established that primary PCI plays a pivotal role in reducing mortality after MI; however, significant variability exists at local, national and regional levels in the provision of primary PCI and associated patient outcomes,” he stated.
The investigators analysed data from the ESC Atlas of Cardiology and the ESC Atlas in Interventional Cardiology, which compile statistics on cardiovascular disease burden, risk factors, outcomes, and management practices to highlight current trends, gaps and disparities in the quality of care. ESC Atlas data were integrated with datasets from the World Health Organisation, the Institute for Health Metrics and Evaluation, and from Eurostat, covering 21 European countries. The association between primary PCI procedures per million inhabitants and age-standardised acute MI mortality rates was assessed, adjusting for confounding variables including the prevalence of cardiovascular disease and gross domestic product (GDP) per capita.
Across the countries analysed, higher GDP per capita was associated with lower age-standardised MI mortality rates, demonstrating a moderate inverse correlation (population correlation coefficient=−0.54; p=0.004). Conversely, greater cardiovascular disease prevalence was associated with higher age-standardised MI mortality rates (population correlation coefficient=+0.45; p=0.02).
Following adjustment for GDP per capita and cardiovascular disease prevalence, a moderate positive correlation emerged: higher rates of primary PCI were associated with increased age-standardised MI mortality (population correlation coefficient=+0.68; p<0.001).
A weak inverse association was identified indicating that a greater number of primary PCI procedures performed per interventional cardiologist was associated with lower MI mortality rates (population correlation coefficient=−0.27; p=0.23).
Co-investigator, Sukruth Pradeep Kundur, also from King’s College London (London, UK), commented: “One would anticipate that increased provision of primary PCI would yield lower mortality rates; therefore, we will conduct additional analyses to elucidate why this trend is not evident in our preliminary findings. The observed association with procedural workload highlights the significance of operator expertise. In addition, system-level factors include inter-centre variability and the interval between symptom onset and access to primary PCI.”
Senior author, Sanjay Sivalokanathan from the Mount Sinai Health System in New York, USA, concluded: “The global rise in cardiometabolic risk factors appears to play a meaningful role in the clinical complexity of patients presenting with acute coronary syndromes. As such, PCI may be challenging in certain settings, highlighting the importance of operator experience and advanced interventional strategies. These developments emphasise the need for collaborative, multidisciplinary approaches, while prevention remains the cornerstone of reducing the overall burden of cardiovascular disease and associated mortality.”
