Ahmad Farshid1, David Brieger2, Karice Hyun3, Christopher Hammett4, Christopher Ellis5, Jamie Rankin6, Jeff Lefkovits7, Derek Chew8, John French9. 1. Department of Cardiology, Canberra Hospital and the Australian National University, Canberra, ACT, Australia. Electronic address: afarshid@tpg.com.au. 2. Department of Cardiology, Concord Hospital and University of Sydney, Sydney, NSW, Australia. 3. The George Institute for Global Health, Sydney, NSW, Australia. 4. Department of Cardiology, Royal Brisbane and Women's Hospital, Brisbane, Qld, Australia. 5. Department of Cardiology, Auckland City Hospital, Auckland, New Zealand. 6. Department of Cardiology, Fiona Stanley Hospital, Perth, WA, Australia. 7. Department of Cardiology, Royal Melbourne Hospital, Melbourne, Vic, Australia. 8. Department of Cardiovascular Medicine, Flinders Medical Centre and Flinders University, Adelaide, SA, Australia. 9. Department of Cardiology, Liverpool Hospital and University of New South Wales, Sydney, NSW, Australia.
Abstract
BACKGROUND: Cohort studies of STEMI patients have reported that over 30% receive no reperfusion. Barriers to greater use of reperfusion in STEMI patients require further elucidation. METHODS: We collected data on STEMI patients with no reperfusion as part of the SNAPSHOT ACS Registry, which recruited consecutive ACS patients in 478 hospitals throughout Australia and New Zealand during 14-27 May 2012. RESULTS: Of 4387 patients enrolled, 419 were diagnosed with STEMI. Primary PCI (PPCI) was performed in 160 (38.2%), fibrinolysis was used in 105 (25.1%), and 154 (36.7%) had no reperfusion. Patients with no reperfusion had a mean age of 70.3±15.0 years compared with 63.1±13.5 in the reperfusion group (p<0.0001). There were more females in the no reperfusion group (37.1% v 23.0% p=0.002) and they were significantly more likely to have prior PCI or CABG, heart failure, atrial fibrillation, chronic kidney disease and other vascular disease, and to be nursing home residents (all p<0.05). Patients without reperfusion had a significantly higher mortality in hospital (11.7% v 4.9%, p=0.011). In 370 patients who presented within 12hours, 28 had early angiography without PCI, which was considered an attempt at reperfusion. Therefore reperfusion was attempted in 293 of 370 eligible patients (79.2%). CONCLUSION: Of consecutive STEMI patients, 36.7% did not receive any reperfusion and they had a higher risk of death in hospital. In eligible patients, reperfusion was attempted in 79.2%. National strategies to encourage earlier medical contact and greater use of reperfusion in eligible patients may lead to better outcomes.
BACKGROUND: Cohort studies of STEMI patients have reported that over 30% receive no reperfusion. Barriers to greater use of reperfusion in STEMI patients require further elucidation. METHODS: We collected data on STEMI patients with no reperfusion as part of the SNAPSHOT ACS Registry, which recruited consecutive ACS patients in 478 hospitals throughout Australia and New Zealand during 14-27 May 2012. RESULTS: Of 4387 patients enrolled, 419 were diagnosed with STEMI. Primary PCI (PPCI) was performed in 160 (38.2%), fibrinolysis was used in 105 (25.1%), and 154 (36.7%) had no reperfusion. Patients with no reperfusion had a mean age of 70.3±15.0 years compared with 63.1±13.5 in the reperfusion group (p<0.0001). There were more females in the no reperfusion group (37.1% v 23.0% p=0.002) and they were significantly more likely to have prior PCI or CABG, heart failure, atrial fibrillation, chronic kidney disease and other vascular disease, and to be nursing home residents (all p<0.05). Patients without reperfusion had a significantly higher mortality in hospital (11.7% v 4.9%, p=0.011). In 370 patients who presented within 12hours, 28 had early angiography without PCI, which was considered an attempt at reperfusion. Therefore reperfusion was attempted in 293 of 370 eligible patients (79.2%). CONCLUSION: Of consecutive STEMI patients, 36.7% did not receive any reperfusion and they had a higher risk of death in hospital. In eligible patients, reperfusion was attempted in 79.2%. National strategies to encourage earlier medical contact and greater use of reperfusion in eligible patients may lead to better outcomes.
Authors: Paul Michael Haller; Bernhard Jäger; Serdar Farhan; Günter Christ; Wolfgang Schreiber; Franz Weidinger; Thomas Stefenelli; Georg Delle-Karth; Alfred Kaff; Gerald Maurer; Kurt Huber Journal: Wien Klin Wochenschr Date: 2018-03 Impact factor: 1.704
Authors: Josien Engel; Judith M Poldervaart; Ineke van der Wulp; Johannes B Reitsma; Martine C de Bruijne; Jeroen J H Bunge; Maarten J Cramer; Wouter J Tietge; Ruben Uijlings; Cordula Wagner Journal: BMJ Open Date: 2017-01-19 Impact factor: 2.692
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