IJCS | Volume 32, Nº2, March/April 2019

DOI: 10.5935/2359-4802.20180090 125 ORIGINAL ARTICLE International Journal of Cardiovascular Sciences. 2019;32(2)125-133 Mailing Address: Guilherme Pinheiro Machado Rua Domingos Crescencio, 545. Postal Code: Santana, Porto Alegre, RS - Brazil. E-mail: gpmachado89@gmail.com , guimachado@hcpa.edu.br An Overview of Care Changes in the Last 6 Year in Primary PCI in ST-Elevation Myocardial Infarction in a Tertiary University Brazilian Hospital Guilherme Pinheiro Machado, 1, 2 Fernando Pivatto Junior, 2 R odrigo Wainstein, 2 G ustavo Neves de Araujo, 2 Christian Kunde Carpes, 1, 2 Mateus Correa Lech, 1, 2 F elipe Homem Valle, 2 L uiz Carlos Corsetti Bergoli, 2 S andro Cadaval Gonçalves, 2 M arco VugmanWainstein 1, 2 Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, 1 RS - Brazil Serviço de Cardiologia, Hospital de Clínicas de Porto Alegre, 2 RS - Brazil Manuscript received on February 27, 2018, revised manuscript on June 26, 2018, accepted on August 07, 2018. Abstract Background: Although new studies and guidelines can be considered useful tools, it does not necessarily mean they are put into clinical practice. Objective: The aim of the current analysis was to assess the changes in primary percutaneous coronary intervention (PCI) and mortality in a tertiary university hospital in southern Brazil during a six-year period. Methods: We have included consecutive patients with ST-elevation myocardial infarction (STEMI) who underwent primary PCI between March 2011 and February 2017. Previous clinical history, characteristics of the procedure, and reperfusion strategies were collected. In-hospital, short and long-term mortalities were also evaluated. The significance level adopted for all tests was 5%. Results: There was an increase in the use of radial access in patients from 20.0% in 2011 to 62.7% in 2016 (p trend < 0.0001). Moreover, thrombus aspiration decreased significantly from 66.7% in 2011 to less than 3.0% in 2016 (p trend < 0.0001). In-hospital, short and long-term mortalities remained reasonably stable from 2011 to 2016 (p trend > 0.05). However, a lower in-hospital mortality was observed in patients treated through radial access (p < 0.001). Cardiogenic shock occurred in 11.1%, without statistical differences in the period (p trend = 0.39), while long-term mortality rate decreased from 80.0% in 2011 to 27.3% in 2016 in this patient group (p trend = 0.29). Conclusions: During a 6-year follow-up period, primary PCI characteristics underwent important modifications. Radial access became widely used, with a decrease in mortality with the use of this route, while aspiration thrombectomy became a rare procedure. The incidence of cardiogenic shock remained stable, but has shown a reduction in its mortality. (Int J Cardiovasc Sci. 2019;32(2)125-133) Keywords: Myocardial Infarction/mortality; Percutaneous Coronary Intervention; Mortality; Shock, Cardiogenic. Introduction Coronary artery disease remains the main cause of death worldwide. 1 Among its clinical spectrum, acute myocardial infarction (AMI) is a major cause of higher mortality, despite continuous therapeutic advances in the recent decades. It is known that early and effective reperfusion therapy of ST-elevation myocardial infarction (STEMI) is the most important component of the treatment, being responsible for the infarct size reduction, ventricular function preservation and a significant decrease in morbidity and mortality. Furthermore, the benefit of any type of treatment decreases as the time to symptom onset increases. 2 Recent evidence from large randomized trials and meta-analyses has changed the clinical practice, suggesting that primary percutaneous coronary