Register of percutaneous coronary interventions: expanded comparative analysis of results of 2016 and 20 17. From reperfusion paradox to decrease of mortality

Abstract

Ukrainian Association of Interventional Cardiology established Percutaneous Coronary Interventions Registry (PCI Registry) in 2010. The first protocol was filled on 12.04.2010. By now (23.07.2018, 17 h 58 min) the Registry was filled by 106,244 patients who underwent coronary angiography, percutaneous coronary intervention (PCI) or both procedures simultaneously. For the year 2017 in the clinics participating in the Registry, coronary angiography was performed on 32,112 patients (+9.3 %), PCI — on 14,510 patients (+12.6 %), PCI in STEMI patients — in 7,846 cases (+6 %). The number of PCI in patients with STEMI per million of population increased by 8.0 % compared to 2016 and amounted to 220 patients. The number of STEMI patients hospitalized for percutaneous reperfusion was quite adequate and corresponded to the main world trends in the treatment of acute myocardial infarction (0 — 4h — 44 %, 4 — 6h — 22 %, 6 — 12h — 20 %, 12 — 24h — only 14 %, respectively). The indicators of hospital mortality have noticeably changed in 11 regions of Ukraine (Vinnytsia, Dnipropetrovsk, Transcarpathian, Ivano-Frankivsk, Kyiv (together with the city of Kyiv), Lviv, Odesa, Poltava, Kharkiv, Kherson, Cherkasy), which have half of the population of the country and established regional reperfusion networks. The decrease of mortality due to acute myocardial infarction (АМІ) was statistically significant (p < 0.0001). The average hospital mortality in these regions was 11.6 % (14.2 % in the same regions in 2015), which is 18.3 % lower than in 2015. As a result of these changes in same areas in 2017, 420 lives more were saved than in 2015. The decrease in mortality in 11 regions caused a slight decrease in hospital mortality rate from AMI in the country: by 12.5 % in 2017, by 13.2 % in 2016. In some regions general indicators are still high. There was a tendency to increase the frequency of detection of patients with AMI without ST segment elevation: in 2016 — 424 per 1 million people, in 2017 — 489. Such an increase is fixed first during the existence of the Registry. It is possible that this phenomenon is caused by the consequences of the reperfusion paradox, which, in fact, were already pointed out during the development of the reperfusion system in European countries.