Results of primary percutaneous coronary intervention in a consecutive group of patients with acute ST elevation myocardial infarction at a tertiary Australian centre

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Abstract:

Abstract Background:

Multicentre randomized controlled trials (RCT) of primary percutaneous coronary intervention (PCI) for ST elevation myocardial infarction (STEMI) have consistently shown lower mortality compared with fibrinolysis, if carried out in a timely manner. Although primary PCI is now standard of care in many centres, it remains unknown whether results from RCT of selected patients are generalizable to a ‘real-world’ Australian setting. The primary goal of this study was to evaluate whether a strategy of routine invasive management for patients with STEMI can achieve 30-day and 12-month mortality rates comparable with multicentre RCT. Secondary goals were to determine 30-day mortality rates in prespecified high-risk subgroups, and symptom-onset- and door-to-balloon-inflation times. Methods:

A retrospective observational study of 189 consecutive patients treated with primary PCI for STEMI in a single Australian centre performing PCI for acute STEMI. Results:

All-cause mortality was 6.9% at 30 days, and 10.4% at 12 months. Mortality in patients presenting without cardiogenic shock was low (2.4% at 30 days; 5.0% at 12 months), whereas 12-month mortality in patients with shock was higher, particularly in the elderly (29.4% for patients <75 years; 85.7% for patients ≥75 years, P = 0.01). Symptom-onset-to-balloon-inflation time was ≤4 h in 56% of patients (median 231 min); however, a door-to-balloon time of <90 min was achieved in only 20% (median 133 min). Conclusion:

Mortality and symptom-onset-to-balloon-inflation times reported in RCT of primary PCI for STEMI are generalizable to ‘real-world’ Australian practice; however, further efforts to reduce door-to-balloon times are required.

Keywords: emergency treatment; mortality outcomes assessment; myocardial infarction; percutaneous transluminal angioplasty

Document Type: Research Article

DOI: http://dx.doi.org/10.1111/j.1445-5994.2007.01357.x

Affiliations: 1: Department of Cardiology, Austin Health 2: Department of Cardiology, Royal Brompton Hospital, London, United Kingdom 3: Department of Cardiology, Box Hill Hospital, Melbourne, Victoria, Australia

Publication date: July 1, 2007

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