Temporal changes in the current practice of primary angioplasty: a real life experience of a single high-volume center

• Net benefit effect demonstrated in randomized clinical trials (RCT) might not be the same as that observed in different clinical settings. Large observational registries are needed in order to assessing treatment effectiveness in patients encountered in day-to-day clinical practice, undergoing everyday therapy.
• After the publication of pivotal randomized trial and large registries, there were significant changes in the current practice of primary PCI in a high primary PCI-volume catheterization laboratory.
• We reported an increase of the trans-radial approach, of the use of either bivalirudin or new antiplatelet drugs or DES and a significant decrease of the use of either GP IIb–IIIa inhibitors or IABP. Conversely the rates of manual thrombus aspiration and multivessel PCI remained almost unchanged.
• These changes could have had an impact on procedural efficacy.

BackgroundIn the last years, new techniques, drugs and devices have been introduced in the current practice of primary angioplasty (PPCI) and validated by pivotal studies The objective of our study was to evaluate if these studies have led to significant changes on the current practice of primary PCI in our center.MethodsFrom March 2003 to December 2013 1980 patients with ST-segment elevation myocardial infarction underwent PPCI within 12-hours of onset of symptoms. We considered 2 periods of our activity: from 2003 to 2009 (P1) with 1078 patients and from 2010 to 2013 (P2) with 902 patients, and compared them in terms of pharmacological and arterial access strategies and of devices utilization.ResultsIn P2 there was a significant increase of radial access (34.1% vs. 1.5, p < 0.001), as well as of the use of bivalirudin (22.7% vs. 0.5%, p < 0.001) and of new antiplatelet drugs (prasugrel or ticagrelor) (18.3% vs. 0%, p < 0.001) whereas the use of GP IIb–IIIa and of intraaortic balloon pump significantly decreased (from 82.3% to 52%, p < 0.001 and from 17% to 7.5%, p < 0.001 respectively). In the P2 there was a significant increase of the procedural efficacy (97.2% vs. 95.1%, p = 0.01) that persisted after the logistic regression adjustment (OR 2.09, CI 95%, 1.04–4.21).ConclusionsOur study shows that in the last years, in a high-PCI center, after the publication of pivotal randomized trial and nationwide registries, there were significant changes in the PPCI current practice that could have had an impact on procedural efficacy.