BACKGROUND: Randomized controlled trials have established the clinical superiority of primary percutaneous coronary intervention (PCI) over fibrinolysis for ST segment elevation myocardial infarction (STEMI) in selected populations. However, the clinical effectiveness of the primary PCI strategy with modern adjunctive antiplatelet therapy deserves further evaluation. OBJECTIVE: To validate results from randomized controlled trials in a nonselected Canadian population. METHODS: A retrospective study of 243 consecutive patients who presented with a STEMI at a single academic centre was performed. Baseline characteristics, treatment strategies and in-hospital outcomes of patients treated in 2004 to 2005 (n=129) were compared with those of patients treated in 1999 to 2000 (n=114). Logistic regression was used to adjust for imbalanced baseline characteristics. RESULTS:Patients in the 2004 to 2005 cohort versus those in the 1999 to 2000 cohort were older and more likely to be hypertensive and to present in Killip class 2 to 4. All of the patients treated in 2004 to 2005 underwent a primary PCI strategy compared with 32.5% in the 1999 to 2000 cohort. The in-hospital incidence of death, reinfarction or stroke was reduced from 21.9% in 1999 to 2000, to 15.5% in 2004 to 2005 (adjusted OR 0.462; P=0.055), largely due to a reduction in reinfarction (10.5% to 3.1%, adjusted OR 0.275; P=0.041). In-hospital mortality and stroke rates did not change significantly. The median length of stay was reduced from eight to six days in the recent cohort (P=0.002). CONCLUSIONS: In the present nonselected population, the change in reperfusion strategy from fibrinolysis to primary PCI in the treatment of STEMI reduced the length of hospitalization by two days and was associated with an adjusted 54% relative reduction in adverse in-hospital events, which was largely due to a significant reduction in reinfarction.
RCT Entities:
BACKGROUND: Randomized controlled trials have established the clinical superiority of primary percutaneous coronary intervention (PCI) over fibrinolysis for ST segment elevation myocardial infarction (STEMI) in selected populations. However, the clinical effectiveness of the primary PCI strategy with modern adjunctive antiplatelet therapy deserves further evaluation. OBJECTIVE: To validate results from randomized controlled trials in a nonselected Canadian population. METHODS: A retrospective study of 243 consecutive patients who presented with a STEMI at a single academic centre was performed. Baseline characteristics, treatment strategies and in-hospital outcomes of patients treated in 2004 to 2005 (n=129) were compared with those of patients treated in 1999 to 2000 (n=114). Logistic regression was used to adjust for imbalanced baseline characteristics. RESULTS:Patients in the 2004 to 2005 cohort versus those in the 1999 to 2000 cohort were older and more likely to be hypertensive and to present in Killip class 2 to 4. All of the patients treated in 2004 to 2005 underwent a primary PCI strategy compared with 32.5% in the 1999 to 2000 cohort. The in-hospital incidence of death, reinfarction or stroke was reduced from 21.9% in 1999 to 2000, to 15.5% in 2004 to 2005 (adjusted OR 0.462; P=0.055), largely due to a reduction in reinfarction (10.5% to 3.1%, adjusted OR 0.275; P=0.041). In-hospital mortality and stroke rates did not change significantly. The median length of stay was reduced from eight to six days in the recent cohort (P=0.002). CONCLUSIONS: In the present nonselected population, the change in reperfusion strategy from fibrinolysis to primary PCI in the treatment of STEMI reduced the length of hospitalization by two days and was associated with an adjusted 54% relative reduction in adverse in-hospital events, which was largely due to a significant reduction in reinfarction.
Authors: Adnan Kastrati; Julinda Mehilli; Josef Dirschinger; Ullrich Schricke; Jodi Neverve; Jürgen Pache; Stefan Martinoff; Franz Josef Neumann; Stephan Nekolla; Rudolf Blasini; Melchior Seyfarth; Markus Schwaiger; Albert Schömig Journal: Lancet Date: 2002-03-16 Impact factor: 79.321
Authors: M R Le May; M Labinaz; R F Davies; J F Marquis; L A Laramée; E R O'Brien; W L Williams; R S Beanlands; G Nichol; L A Higginson Journal: J Am Coll Cardiol Date: 2001-03-15 Impact factor: 24.094
Authors: Thomas Aversano; Lynnet T Aversano; Eugene Passamani; Genell L Knatterud; Michael L Terrin; David O Williams; Sandra A Forman Journal: JAMA Date: 2002-04-17 Impact factor: 56.272
Authors: C P Cannon; C M Gibson; C T Lambrew; D A Shoultz; D Levy; W J French; J M Gore; W D Weaver; W J Rogers; A J Tiefenbrunn Journal: JAMA Date: 2000-06-14 Impact factor: 56.272
Authors: James G Jollis; Mayme L Roettig; Akinyele O Aluko; Kevin J Anstrom; Robert J Applegate; Joseph D Babb; Peter B Berger; David J Bohle; Sidney M Fletcher; J Lee Garvey; William R Hathaway; James W Hoekstra; Robert V Kelly; William T Maddox; Joseph R Shiber; F Scott Valeri; Bradley A Watling; B Hadley Wilson; Christopher B Granger Journal: JAMA Date: 2007-11-04 Impact factor: 56.272
Authors: Eric Bonnefoy; Frédéric Lapostolle; Alain Leizorovicz; Gabriel Steg; Eugène P McFadden; Pierre Yves Dubien; Simon Cattan; Eric Boullenger; Jacques Machecourt; Jean-Micel Lacroute; Jean Cassagnes; François Dissait; Paul Touboul Journal: Lancet Date: 2002-09-14 Impact factor: 79.321
Authors: C Michael Gibson; Juhana Karha; Sabina A Murphy; David James; David A Morrow; Christopher P Cannon; Robert P Giugliano; Elliott M Antman; Eugene Braunwald Journal: J Am Coll Cardiol Date: 2003-07-02 Impact factor: 24.094
Authors: Henning R Andersen; Torsten T Nielsen; Klaus Rasmussen; Leif Thuesen; Henning Kelbaek; Per Thayssen; Ulrik Abildgaard; Flemming Pedersen; Jan K Madsen; Peer Grande; Anton B Villadsen; Lars R Krusell; Torben Haghfelt; Preben Lomholt; Steen E Husted; Else Vigholt; Henrik K Kjaergard; Leif Spange Mortensen Journal: N Engl J Med Date: 2003-08-21 Impact factor: 91.245
Authors: Elliott M Antman; Daniel T Anbe; Paul Wayne Armstrong; Eric R Bates; Lee A Green; Mary Hand; Judith S Hochman; Harlan M Krumholz; Frederick G Kushner; Gervasio A Lamas; Charles J Mullany; Joseph P Ornato; David L Pearle; Michael A Sloan; Sidney C Smith Journal: J Am Coll Cardiol Date: 2004-08-04 Impact factor: 24.094