Key Points
- To assess how patient risk factors, reperfusion therapies, and early medication administration affect in-hospital mortality among patients presenting with acute myocardial infarction in modern clinical practice.
- Analyzed data from 7,279 patients admitted with ST-elevation myocardial infarction or new left bundle-branch block in the Swiss AMIS Plus registry between 1997 and 2002.
- Assessed the association between early pharmacotherapy, reperfusion approaches, patient factors, and in-hospital mortality using multivariable logistic regression.
- In-hospital mortality was significantly reduced by reperfusion with thrombolysis (OR 0.69; 95% CI, 0.54–0.87; p = 0.002) and primary percutaneous coronary intervention (OR 0.66; 95% CI, 0.44–0.99; p = 0.044).
- Early use of aspirin (OR 0.63; 95% CI, 0.45–0.89; p = 0.009), ADP antagonists (OR 0.49; 95% CI, 0.35–0.70; p < 0.001), beta-blockers (OR 0.46; 95% CI, 0.37–0.57; p < 0.001), nitrates (OR 0.58; 95% CI, 0.46–0.72; p < 0.001), and ACE inhibitors (OR 0.60; 95% CI, 0.49–0.75; p = 0.009) markedly decreased in-hospital death, whereas unfractionated heparin showed no significant benefit.
Structured PICO
Does early drug therapy and reperfusion therapy reduce in-hospital mortality in patients with acute myocardial infarction with ST elevation or new left bundle-branch block?
PPopulation7,279 patients with acute myocardial infarction with ST elevation or new left bundle-branch block admitted to participating hospitals in Switzerland between 1997 and 2002 (AMIS Plus registry).
IInterventionEarly administration of aspirin, ADP antagonists (ticlopidine or clopidogrel), ACE inhibitors, nitrates, beta-blockers, and reperfusion therapy (thrombolysis or primary PCI).
CComparatorPatients not receiving the respective early drug or reperfusion therapies.
OOutcomeIn-hospital mortalityhard clinical
Early administration of aspirin, ADP inhibitors, beta-blockers, nitrates, and ACE inhibitors, along with reperfusion therapy, significantly reduces in-hospital mortality in patients with STEMI or new LBBB.
Limitations
- Potential selection bias (patients with a lower risk for in-hospital death selected for early invasive assessment may have received ADP inhibitors more frequently)