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Outcome up to one year following different reperfusion strategies in acute ST-segment elevation myocardial infarction: The Helsinki-Uusimaa Hospital District registry of ST-Elevation Acute Myocardial Infarction (HUS-STEMI).
MedLine Citation:
PMID:  24338296     Owner:  NLM     Status:  In-Data-Review    
AIMS: Current guidelines prefer primary percutaneous coronary intervention (pPCI) over fibrinolysis in the treatment of acute ST-elevation myocardial infarction (STEMI). Pre-hospital fibrinolysis followed by early invasive evaluation is an alternative that we have used in patients presenting within three hours of symptom onset. We made a survey of patients suffering an acute STEMI over one year to assess mortality and adverse events following either pPCI or fibrinolysis.
METHODS AND RESULTS: Of the 448 consecutive STEMI patients, 194 were treated with pPCI and 176 underwent fibrinolysis; 78 patients received no reperfusion treatment within 12 hours (NRT group). The median TIMI risk scores were 4.0, 3.0 and 4.0 in the pPCI, fibrinolysis and NRT groups, respectively (p<0.001). Mortality at one year was 14.4% following pPCI, 5.1% following fibrinolysis and 12.8% in the NRT group (p=0.011 across all groups and p=0.003 between pPCI and fibrinolysis, adjusted for differences in risk factors). The one-year composite of cardiovascular death, stroke, reinfarction and new revascularization was 20.1%, 18.2% and 26.9% for the pPCI, fibrinolysis and NRT groups, respectively (p=NS). In patients presenting within three hours of symptom onset, one-year mortality was 3.7% in the fibrinolysis group (n=163) and 15.3% in the pPCI group (n=118) (adjusted p =0.001), while the composite of adverse events was 16.6% in the former group and 19.5% in the latter (p=NS).
CONCLUSION: Pre-hospital fibrinolysis followed by routine early invasive evaluation provides an excellent reperfusion strategy for low-risk STEMI patients presenting early after symptom onset.
Juho Viikilä; Jyrki Lilleberg; Ilkka Tierala; Mikko Syvänne; Markku Kupari; Veikko Salomaa; Markku S Nieminen;
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Publication Detail:
Type:  Journal Article     Date:  2013-08-21
Journal Detail:
Title:  European heart journal. Acute cardiovascular care     Volume:  2     ISSN:  2048-8734     ISO Abbreviation:  Eur Heart J Acute Cardiovasc Care     Publication Date:  2013 Dec 
Date Detail:
Created Date:  2013-12-16     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101591369     Medline TA:  Eur Heart J Acute Cardiovasc Care     Country:  England    
Other Details:
Languages:  eng     Pagination:  371-8     Citation Subset:  IM    
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