Objectives: Primary percutaneous coronary intervention (PCI) remains recommended reperfusion therapy for patients with acute ST-elevation myocardial infarction. This study aimed to evaluate the short-term major adverse cardiac events (MACE) and their determinants among patients who underwent primary PCI at a tertiary care cardiac center of Karachi, Pakistan. Methods: A cohort of patients who underwent primary PCI were followed for the MACE. Multivariable Cox-regression analysis was performed with backward conditional variable selection and hazard ratio (HR) along with 95% confidence interval (CI) were obtained. Results: A total of 1150 patients were included, of which follow-up was successful in 95.8% (1102) and mean follow-up duration was 5.97±2.32 months. MACE were observed in 201 (19.1%) patients with 14.2% (157) all-cause mortality, 5.4% (60) cardiac mortality, 0.7% (8) stroke, 3.6% (40) re-hospitalization due to heart failure, and 6.1% (67) myocardial infarction requiring revascularization. Independent predictors of short-term MACE were found to be admission glucose ≥200 mg/dl (1.66 [1.25-2.21]), serum creatinine ≥1.5 mg/dl (1.52 [1.02-2.27]), intubation (2.81 [1.98-4.00]), history of PCI (2.06 [1.45-2.93]), history of cerebrovascular accident (2.64 [1.34-5.2]), left ventricular end-diastolic pressure ≥20 mmHg (1.81 [1.3-2.51]), triple vessel diseases (1.43 [1.08-1.9]), culprit left main or proximal left anterior descending artery (1.77 [1.32-2.35]), pre-ballooning (2.14 [1.2-3.82]), and thrombus grade ≥4 (2.21 [1.51-3.24]). Conclusions: A significant number of individuals undergone primary PCI are still vulnerable to subsequent short-term MACE, hence, systematic follow-up and early risk stratification should be considered as an integral part of STEMI management protocol specially for patients with high-risk features as highlighted herein.

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