Clinical practice of primary angioplasty for the treatment of acute myocardial infarction in Germany: results from the MITRA and MIR registries.

The pooled data of two German AMI registries: the Maximal Individual Therapy in Acute Myocardial Infarction (MITRA) study and the Myocardial Infarction Registry (MIR) were analysed in order to 1) describe current clinical practice of primary angioplasty in Germany, 2) compare the results of primary angioplasty with those of thrombolysis in the "real world" and 3) define subgroups of patients profiting probably most from primary angioplasty. Between 1994 and 1998, 20,306 AMI patients were included in the registries. At the 271 participating hospitals angioplasty facilities were available at 18.5%. Thrombolysis was still the most frequently used reperfusion therapy at hospitals without (96%) as well as hospitals with such facilities (55%). Transfer of AMI patients for angiography was performed in 3.6% of AMI patients admitted to hospitals without angioplasty facilities. A total of 9906 lytic eligible AMI patients with a pre-hospital delay of no more than 12 hours were treated with either primary angioplasty (n = 1327) or thrombolysis (n = 8579). Univariate analysis of hospital mortality showed a more favourable course for patients treated with primary angioplasty: 6.4% versus 11.3%, OR = 0.54, 95% CI: 0.43-0.67, p < 0.0001. This was confirmed by logistic regression analysis: multivariate OR = 0.58, 95% CI: 0.44-0.77, p < 0.0001. Primary angioplasty was associated with a lower mortality in all subgroups analysed. There was a significant correlation between mortality and the absolute risk reduction (r = 0.82, p < 0.0001) in the different subgroups, which showed an increasing absolute benefit of primary angioplasty compared to thrombolysis with increasing mortality risk.