Trends in acute reperfusion therapy for ST-segment elevation myocardial infarction from 1999 to 2006: we are getting better but we have got a long way to go
Population
10,954 patients with ST elevation or left bundle-branch block presenting within 12 h of symptom onset and…
Design
Cohort
Follow-up
In-hospital
Authors
Discussion
Loading...
Member takes
Implication
STEMI mortality fell alongside rising primary PCI use; associated with temporal trends but leaves open whether closing the 33% reperfusion gap would yield further gains.
Key Points
- To evaluate temporal trends in the utilization, timing, and hospital mortality associated with acute reperfusion therapy for patients presenting with ST-segment elevation myocardial infarction.
- Analyzed 10,954 patients with ST elevation or left bundle-branch block presenting within 12 hours of symptom onset enrolled in the GRACE registry between April 1999 and June 2006.
- Evaluated trends in primary percutaneous coronary intervention (PCI), fibrinolytic therapy, hospital arrival-to-treatment delays, and in-hospital mortality.
- Primary PCI use increased from 15% to 44% (P < 0.001) while fibrinolysis decreased from 41% to 16% (P < 0.01), accompanied by a decline in hospital mortality from 6.9% to 5.4% (P < 0.01).
- One-third (33%) of eligible patients received no reperfusion therapy over the study duration.
- In 2006, 52% of fibrinolysis patients had door-to-needle times >30 minutes and 42% of primary PCI patients had door-to-balloon times >90 minutes.
Structured PICO
P
Population
10,954 patients with ST elevation or left bundle-branch block presenting within 12 h of symptom onset and enrolled in the GRACE registry between April 1999 and June 2006.
I
Intervention
Acute reperfusion therapy (primary percutaneous coronary intervention or fibrinolytic therapy)
O
Outcome
Trends in use of primary PCI and fibrinolytic therapy over timehard clinical
Despite increases in primary PCI utilization and improvements in hospital mortality for STEMI, significant gaps remain in timely access to reperfusion therapy.
Cite This Study
Eagle et al. (2008) studied this question.