Reduced Inhospital Mortality in Patients with Acute Myocardial Infarction after Practice of Percutaneous Coronary Intervention at a Remote Hospital in Taiwan

Background: As of July 2004, our hospital in Taitung, a remote area of Taiwan, has offered a 24-hour primary percutaneous coronary intervention (PCI) service. Methods: We performed a retrospective analysis of data from 310 patients who suffered an acute myocardial infarction (AMI) from the period 2003 and 2007 according to patient age and survival status. Results: The mean age for the non-survivors was significantly higher compared to the survivors. Non-survivors were significantly lower in BMI, higher uric acid levels and were considered to be hyperuricemic. The mortality rate among the 148 older patients ( 70 years of age) was significantly higher than that among the 162 younger patients (< 70 years of age) group (18.37% vs. 3.09%, p < 0.0001). The older patients exhibited higher levels of serum creatine and lower levels of cholesterol, triglycerides, and LDL (p < 0.05 for all). A greater fraction of the older patients were in Killip class III-IV compared to the younger patients (p < 0.0001) and were more likely to be in shock status on arrival (p = .0085). Multivariate logistic regression analysis revealed that age 70 years (OR 8.49, 95% CI 1.04-68.84, p = 0.04) and Killip classes III-IV (OR 7.41, 95% CI 1.54-35.55, p = 0.01) independently predicted in-hospital mortality. The primary PCI service significantly reduced the mortality of younger AMI patients (p = 0.002). The mortality before and after primary PCI in the older age group, by contrast, was not significantly different. Conclusion: Our data suggest that greater age (along with Killip class III-IV) appears to predict in-hospital mortality for patients with AMI. Younger patients can benefit from the availability of a primary PCI service.