3layout original Article dr Anita suryo

Percutaneous Coronary Intervention as Clinical Outcome Predictor for 
in-Hospital Adverse Events in STEMI Patients
Anita Suryo Santoso
1*
, Mohammad Saifur Rohman
2
, Ardian Rizal
2
, Setyasih Anjarwani
2
, Heny martini
2
, 
Indra Prasetya
2
A R T I C L E I N F O
A B S T R A C T
1. Introduction
https://doi.org/10.21776/ub.hsj.2022.003.02.3
Received 9 February 2022; Received in revised form 30 February 2022; Accepted 15 March 2022
*Corresponding author at: Brawijaya Cardiovascular Research Center, Department of Cardiology and Vascular Medicine, Faculty of Medicine, 
Universitas Brawijaya, Malang, Indonesia.
E-mail address: anita.surya.santoso@gmail.com (A. S. Santoso).
Available online 30 April 2021
2214-5400/ ©UB Press. All rights reserved.
Heart Science Journal
Contents list available at 
www.heartscience.ub.ac.id
Heart Sci J 2022; 3(2): 10-17
Journal Homepage : 
www.heartscience.ub.ac.id
Background : Achieving timely reperfusion for patients with ST segment Elevation Myocardial Infarction (STEMI) 
remains a challenging problem in developing countries. This study aimed to determine whether late PPCI is the 
main predictor for in-hospital adverse events in STEMI patients. 
Method : This study will emphasize the incident of in-hospital adverse events and complications between early 
PPCI vs late PPCI vs non revascularization groups. A total of 568 STEMI patients were consecutively enrolled from 
Saiful Anwar General Hospital in between 2018-2021. Patients were subdivided to the timeframe provided by the 
2017 ESC STEMI management guideline. The incidence of in-hospital adverse event were calculated as primary 
endpoints, development of immediate complications during hospitalizations were analyzed as secondary 
endpoints. 
Results : Incidence of in-hospital mortality were significantly higher for patients treated without revascularization 
and lowest in early PPCI group (32.4% and 7.5% respectively, P 0.00). The odds ratio for mortality between early 
PPCI group and non-revascularization groups were significantly lowest (OR 0.17, 95% CI 0.13 – 0.41). Complica-
tions between each treatment groups were significantly different with early PPCI had the lowest incidence of 
in-hospital complications of cardiogenic shock, cardiac arrest, and VT/VF. Stratification of baseline characteristics 
and PCI category reveals that timing PPCI is the main predictor for in-hospital adverse events (HR 4.506, 95% CI 
2.487-6.662, P 0.00). 
Conclusion : Percutaneous coronary intervention is the main predictor for the incidence of in hospital mortality 
and complications in STEMI patients.
Keywords:
STEMI;
PCI;
Mortality;
Complications;
In-Hospital Adverse Events
Primary percutaneous coronary intervention (PPCI) is the 
mainstay treatment strategy for ST-segment elevation myocardial 
infarction (STEMI).
1
Current available guidelines highlighted the 
importance of early management in STEMI patients with strict time 
window of within 12 hours after onset, or within 24 hours after success-
ful fibrinolytic.
2
Early reperfusion of Infarct-related artery (IRA) is the 
primary treatment goal in order to reduce infarct size and residual 
stenosis, improving and preserving left ventricular function, and 
preventing re-occlusion.
2,3
Evidently timing of reperfusion has become 
critical to salvage the damaged myocardium
However, in clinical setting it is challenging to follow the 
timeframe provided by the guidelines especially in developing 
countries.
4
The ability to perform early PPCI is heavily dependent on 
geographical condition and availability of PCI-capable hospital in an 
area.
5
Several studies mentioned that in developing countries only a 
third of STEMI patients receive early PPCI5,6. While the rest of the 
patients were treated with late PPCI or optimal medical therapy only.
4
Many studies conducted in developing countries focused on 
the impact of early versus late reperfusion in Acute Myocardial Infarc-
tion. Aside from evaluating short-term and long-term outcome of 
patients with late presenter, these studies also investigate the optimal 
timing for PPCI in a relatively limited resources setting.
4-9
Differential results provided in the literatures prompted a 
debate on the optimum time of PPCI in late presenting STEMI 
patients.
4-7,9-18
In Indonesia, limited studies are available in investigat-
ing the effect of late PPCI in STEMI patients. Therefore, we performed 
a descriptive analytic study using the Acute Coronary Syndrome (ACS) 
Registry in Saiful Anwar General Hospital Malang. This study will 
evaluate the effect of PPCI as a predictor of in-hospital clinical outcome 
in STEMI patients. In-hospital clinical outcome was 
10
Original Article
Brawijaya Cardiovascular Research Center, Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Brawijaya, Malang, Indonesia.
Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Brawijaya, Malang, Indonesia.
1
2

A. S. Santoso, et al.
Heart Sci J 2022; 3(2): 10-17
defined as mortality during hospital stay within STEMI patients. 
Further, we analyze the impact of late PPCI in the development of 
complications contributing to the in-hospital clinical outcome. 
Additionally we also include a cost analysis and length of stay compari-
son in between STEMI patients receiving early PPCI vs late PPCI vs 
optimal medical therapy to fully comprehend the extent of PPCI in the 
treatment of STEMI.