Research Article Strategies to Lower In-Hospital Mortality in STEMI Patients with Primary PCI: Analysing Two Years Data from a High-Volume Interventional Centre Alexandru Burlacu , 1 Grigore Tinica , 2 Igor Nedelciuc, 3 Paul Simion, 3 Bogdan Artene, 3 and Adrian Covic 4,5 1 Head of Department of Interventional Cardiology—Cardiovascular Diseases Institute, “Grigore T. Popa” University of Medicine, Iasi, Romania 2 Department of Cardiovascular Surgery—Cardiovascular Diseases Institute, “Grigore T. Popa” University of Medicine, Iasi, Romania 3 Department of Interventional Cardiology—Cardiovascular Diseases Institute, Iasi, Romania 4 Nephrology Clinic, Dialysis and Renal Transplant Center—“C.I. Parhon” University Hospital, “Grigore T. Popa” University of Medicine, Iasi, Romania 5 e Academy of Romanian Scientists (AOSR), Iasi, Romania Correspondence should be addressed to Alexandru Burlacu; alburlacu@yahoo.com Received 11 June 2019; Accepted 5 September 2019; Published 1 October 2019 Academic Editor: ach N. Nguyen Copyright © 2019 Alexandru Burlacu et al. is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Objectives. We aimed to analyse data from our high-volume interventional centre (>1000 primary percutaneous coronary interventions (PCI) per year) searching for predictors of in-hospital mortality in acute myocardial infarction (MI) patients. Moreover, we looked for realistic strategies and interventions for lowering in-hospital mortality under the “5 percent threshold.” Background. Although interventional and medical treatment options are constantly expanding, recent studies reported a residual in-hospital mortality ranging between 5 and 10 percent after primary PCI. Current data sustain that mortality after ST-elevation MI will soon reach a point when cannot be reduced any further. Methods. In this retrospective observational single-centre cohort study, we investigated two-year data from a primary PCI registry including 2035 consecutive patients. Uni- and multivariate analysis were performed to identify independent predictors for in-hospital mortality. Results. All variables correlated with mortality in univariate analysis were introduced in a stepwise multivariate linear regression model. Female gender, hypertension, depressed left ventricular ejection fraction, history of MI, multivessel disease, culprit left main stenosis, and cardiogenic shock proved to be independent predictors of in-hospital mortality. e model was validated for sensitivity and specificity using receiver operating characteristic curve. For our model, variables can predict in-hospital mortality with a specificity of 96.60% and a sensitivity of 84.68% (p < 0.0001, AUC  0.93, 95% CI 0.922–0.944). Conclusions. Our analysis identified a predictive model for in- hospital mortality. e majority of deaths were due to cardiogenic shock. We suggested that in order to lower mortality under 5 percent, focus should be on creating a cardiogenic shock system based on the US experience. A shock hub-centre, together with specific transfer algorithms, mobile interventional teams, ventricular assist devices, and surgical hybrid procedures seem to be the next step toward a better management of ST-elevation MI patients and subsequently lower death rates. 1. Introduction Myocardial infarction (MI) remains one of the leading causes of global cardiovascular burden [1]. Even if numerous efforts have been made to increase awareness, prevention, and management of acute MI, it still has a high incidence—ST-elevation myocardial infarction (STEMI) accounting for high mortality and morbidity rates [2]. Since 2008, when “Stent for Life” ini- tiative expanded throughout all Europe (including Eastern countries), death rates in STEMI decreased to a plateau [3]. Although interventional and medical treatment options are constantly expanding, recent studies reported a residual Hindawi Journal of Interventional Cardiology Volume 2019, Article ID 3402081, 6 pages https://doi.org/10.1155/2019/3402081