Long-term Clinical Outcome and MIBI SPECT Parameters in Percutaneous Coronary Interventions

Background and Aim

Primary percutaneous coronary intervention (PCI) is the preferred treatment option for acute myocardial infarction (MI). Off-site PCI reduces time-to-treatment, which could potentially lead to enhanced clinical outcomes. Therefore, we investigated whether off-site PCI improves 5-year clinical outcomes compared with on-site PCI and whether this is related to in-hospital ^99mTc-sestamibi single photon emission computed tomography (MIBI SPECT) parameters.

Methods

We describe the 5-year follow-up for a combined endpoint of death or re-infarction in 128 patients with acute MI who were randomly assigned to undergo primary PCI at the off-site centre (n?=?68) or to transferral to an on-site centre (n?=?60). Three days after PCI, MIBI SPECT was performed to estimate infarct size. A multivariate Cox regression model was created to study the relation between MIBI SPECT parameters and long-term clinical outcomes.

Results

After a mean follow-up of 5.8?±?1.1 years, 25 events occurred. Off-site PCI significantly reduced door-to-balloon time compared with on-site PCI (94?±?54 versus 125?±?59 min, p?=?0.003). However, infarct size (17?±?15 versus 14?±?12%, p?=?0.34) and 5-year death or infarct rate (21% versus 18%, p?=?0.75) were comparable between treatment centres. With multivariate analysis, only Killip class ≥2 and Q wave MI, but not scintigraphic data, predicted long-term clinical outcomes.

Conclusion

Off-site PCI reduced door-to-balloon time with a comparable 5-year death or infarct rate. Parameters from resting MIBI SPECT on day 3 after MI did not predict long-term clinical outcomes.