Successful Implementation of Primary Percutaneous Coronary Intervention in an Iranian Population: A Single-Center Experience

Document Type : Original Article


1 Cardiovascular Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, IR Iran.

2 Interventional Cardiovascular Unit, Santa Corona General Hospital, Pietra Ligure, Italy.

3 Molecular Medicine Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, IR Iran.


Background: Primary percutaneous coronary intervention (PPCI) is the gold standard for the treatment of ST-segment-elevation myocardial infarction (STEMI). Guidelines emphasize the importance of STEMI networks in order to facilitate rapid acute reperfusion therapy and improve prognosis. The outcomes of PPCI in a single tertiary university hospital in Hormozgan Province in Iran are reported herein.
Methods: We performed an observational study including all the consecutive STEMI cases admitted to our interventional cardiology department. Symptom to door, door to ECG, door to diagnosis, door to cath lab, door to balloon, and mortality were reported. Descriptive statistics (median, quartile 1-3) and nonparametric tests (Kruskal–Wallis and Mann–Whitney) were used.
Results: Totally, 195 patients were considered eligible for PPCI. The mean age of the patients was 54.90 years old (range =21–91 y). Women accounted for 28.2% of the study population. All the patients successfully underwent PPCI with a 100% rate of stenting. The in-hospital mortality rate was 1.45%. The median time for symptom-to-door, door-to-diagnosis, code-activation, symptom-to-device, and door-to-device times was 167.50, 23, 35, 266, and 60 minutes, respectively.
Conclusions: Our results, in line with previous studies, confirm the role of PPCI as the frontline approach to STEMI. Our results display the continuous efforts provided to reduce the inhospital procedural times; nevertheless, ongoing efforts are needed to decrease symptom-todoor times.


1. V.L. Roger, A.S. Go, D.M. Lloyd-Jones, E.J.
Benjamin, J.D. Berry, W.B. Borden, et al.;
Executive summary: heart disease and stroke
statistics--2012 update: a report from the
American Heart Association., Circulation. 2012,
2. M.R. Le May, D.Y. So, R. Dionne, C.A. Glover,
M.P. V Froeschl, G.A. Wells, et al.; A citywide
protocol for primary PCI in ST-segment
elevation myocardial infarction., N. Engl. J.
Med. 2008, 358: 231–240.
3. J. Knot, P. Widimsky, W. Wijns, U.
Stenestrand, S.D. Kristensen, A. Van’ T Hof, et
al.; How to set up an effective national primary
angioplasty network: lessons learned from five
European countries., EuroIntervention J. Eur. Collab. with Work. Gr. Interv. Cardiol. Eur.
Soc. Cardiol. 2009, (5) 299,301-309.
4. S. Arshad, S. Dhakam, S. Awan, Outcomes in
ST elevation Myocardial Infarction; a
comparison of a tertiary care center in Pakistan
with European centers., J. Pak. Med. Assoc.
2011, 61:1215–1219.
5. P.G. Steg, S.K. James, D. Atar, L.P. Badano, C.
Blomstrom-Lundqvist, M.A. Borger, C. et al.;
ESC Guidelines for the management of acute
myocardial infarction in patients presenting with
ST-segment elevation., Eur. Heart J. 33
6. J. Chandrasekhar, P. Marley, C. Allada, D.
McGill, S. O’Connor, M. Rahman, et al.;
Symptom-to-Balloon Time is a Strong Predictor
of Adverse Events Following Primary
Percutaneous Coronary Intervention: Results
From the Australian Capital Territory PCI
Registry., Heart. Lung Circ. 2017, 26 41–48.
7. M. Gilard, J. Fajadet, L. Belle, D. Carrie, Y.
Cottin, J.-L. Ducasse, J.-J. Dujardin, et al.; Stent
for Life in France., EuroIntervention J. Eur.
Collab. with Work. Gr. Interv. Cardiol. Eur.
Soc. Cardiol. (8) 2012, Suppl P; P77-9.
8. A. Ahmadi, H. Soori, Y. Mehrabi, K. Etemad,
T. Samavat, A. Khaledifar, Incidence of acute
myocardial infarction in Islamic Republic of
Iran: a study using national registry data in
2012., East. Mediterr. Health J. 2015, (21) 5–12.
9. O. Goktekin, G. Ertas, U. Kervan, O. Koc, O.
Kozan, Stent for Life project: present situation
in Turkey., EuroIntervention J. Eur. Collab.
with Work. Gr. Interv. Cardiol. Eur. Soc.
Cardiol. 8 Suppl P. 2012:P133-5.
10. WHO | Impact of misclassification on measures
of cardiovascular disease mortality in the
Islamic Republic of Iran: a cross-sectional
study, WHO. (2011).
046532/en/ (accessed June 21, 2017).
11. Hormozgan Province, (n.d.).
12. Y. Dadjoo, Yahya; Mahmoodi, The Prognosis of
Primary Percutaneous Coronary Intervention
after One Year Clinical Follow Up 7; 2013;
(1):21-24, Int Cardivasc Res J. 7 21–24.
13. D. Xavier, P. Pais, P.J. Devereaux, C. Xie, D.
Prabhakaran, K.S. Reddy, R. et al.; Treatment
and outcomes of acute coronary syndromes in
India (CREATE): a prospective analysis of
registry data., Lancet (London, England). 371
2008; 1435–1442.
14. C.-C. Lai, K.-C. Chang, P.-C. Liao, C.-T. Wu,
W.-T. Lai, et al.; Effects of Door-to-Balloon
Times on Outcomes in Taiwanese Patients
Receiving Primary Percutaneous Coronary
Intervention: A Report of Taiwan Acute
Coronary Syndrome Full Spectrum Registry.,
Acta Cardiol. Sin. 31 2015; 215–225.
15. H.K. Kim, M.H. Jeong, Y. Ahn, S.C. Chae, Y.J.
Kim, S.H. Hur, et al.; Relationship between time
to treatment and mortality among patients
undergoing primary percutaneous coronary
intervention according to Korea Acute
Myocardial Infarction Registry., J. Cardiol. 69.
2017; 377–382.
16. F.P. Schmidt, A. Perne, M. Hochadel, E.
Giannitsis, H. Darius, L.S. Maier, et al.;
Characterization and referral patterns of STelevation myocardial infarction patients
admitted to chest pain units rather than directly
to catherization laboratories. Data from the
German Chest Pain Unit Registry., Int. J.
Cardiol. 231. 2017: 31–35.
17. H. Farshidi, S. Rahimi, A. Abdi, S. Salehi, A.
Madani, Factors Associated With Pre-hospital
Delay in Patients With Acute Myocardial
Infarction., Iran. Red Crescent Med. J. 15. 2013:
18. M. Dilic, I. Terzic, M. Kulic, Primary
percutaneous coronary intervention network in
Bosnia and Herzegovina: Where are we now
and how to improve PCI network., Int. J.
Cardiol. 217 Suppl. 2016: S49-51.
19. G.S. Youssef, H.H. Kassem, O.A. Ameen, H.S.
Al Taaban, H.H. Rizk, Pre-hospital and hospital
delay in patients with non-ST elevation acute
coronary syndromes in tertiary care, Egypt.
Hear. J. (n.d.).

20. S.D. Kristensen, K.G. Laut, J. Fajadet, Z.
Kaifoszova, P. Kala, C. Di Mario, et al.;
Reperfusion therapy for ST elevation acute
myocardial infarction 2010/2011: current status
in 37 ESC countries., Eur. Heart J. 35, 2014;
21. S. Dharma, H. Andriantoro, I. Dakota, I.
Purnawan, V. Pratama, H. Isnanijah, et al.;
Organisation of reperfusion therapy for STEMI
in a developing country., Open Hear. 2 ; 2015.
22. M. Sobhy, M. Sadaka, N. Okasha, E.S. Farag,
A. Saleh, H. Ismail, et al.; Stent for Life
Initiative placed at the forefront in Egypt 2011.,
EuroIntervention J. Eur. Collab. with Work. Gr.
Interv. Cardiol. Eur. Soc. Cardiol. 8 Suppl P.
2012: P108-15.
23. D.M. Nestler, A. Noheria, L.H. Haro, L.G.
Stead, W.W. Decker, L.N. Scanlan-Hanson, et
al.; Sustaining improvement in door-to-balloon
time over 4 years: the Mayo clinic ST-elevation
myocardial infarction protocol., Circ.
Cardiovasc. Qual. Outcomes. 2; 2009: 508–13.
24. R. Parikh, R. Faillace, A. Hamdan, D. Adinaro,
J. Pruden, V. DeBari, et al.; An emergency
physician activated protocol, “Code STEMI”
reduces door-to-balloon time and length of stay
of patients presenting with ST-segment
elevation myocardial infarction., Int. J. Clin.
Pract. 63; 2009: 398–406.
25. Ostrzycki, C. Sosnowski, A. BorowiecKocanda, T. Zera, K. Pienkowska, D. DropDzwonkowska, et al.; Pre-hospital delay of
treatment in patients with ST segment elevation
myocardial infarction undergoing primary
percutaneous coronary intervention: experience
of cardiac centre located in the vicinity of the
centre of Warsaw., Kardiol. Pol. 66. 2008: 606–
26. N. Danchin, P. Coste, J. Ferrieres, P.-G. Steg, Y.
Cottin, D. Blanchard, et al.; Comparison of
thrombolysis followed by broad use of
percutaneous coronary intervention with
primary percutaneous coronary intervention for
ST-segment-elevation acute myocardial
infarction: data from the french registry on acute
ST-elevation myocardial inf, Circulation. 118.
2008; 268–276.
27. M.C. Peterson, T. Syndergaard, J. Bowler, R.
Doxey, A systematic review of factors
predicting door to balloon time in ST-segment
elevation myocardial infarction treated with
percutaneous intervention., Int. J. Cardiol. 157;
2012: 8–23.
28. S.S. Jolly, S. James, V. Džavík, J.A. Cairns,
K.D. Mahmoud, F. Zijlstra, et al.; Thrombus
Aspiration in ST-Segment–Elevation
Myocardial Infarction, Circulation. 135. 2017;
143 LP-152.
29. P.B. Parikh, A. Jeremias, S.S. Naidu, S.J.
Brener, R.A. Shlofmitz, T. Pappas, et al.;
Determinants of bare-metal stent use in patients
with ST-elevation myocardial infarction
undergoing primary percutaneous coronary
intervention., J. Invasive Cardiol. 25. 2013:114–
30. P.R. Sinnaeve, P.W. Armstrong, A.H. Gershlick,
P. Goldstein, R. Wilcox, Y. Lambert, et al.; STsegment-elevation myocardial infarction
patients randomized to a pharmaco-invasive
strategy or primary percutaneous coronary
intervention: Strategic Reperfusion Early After
Myocardial Infarction (STREAM) 1-year
mortality follow-up., Circulation. 130, 2014: