Document Detail

Reperfusion therapy in the acute management of ST-segment-elevation myocardial infarction in Australia: findings from the ACACIA registry.
MedLine Citation:
PMID:  21034381     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To describe the contemporary management and outcomes of patients presenting with ST-segment-elevation myocardial infarction (STEMI) in Australia.
DESIGN, PARTICIPANTS AND SETTING: Observational analysis of data for patients who presented with suspected STEMI and enrolled in the Australian Acute Coronary Syndrome Prospective Audit from 1 November 2005 to 31 July 2007.
MAIN OUTCOME MEASURES: Factors associated with use of reperfusion therapy and timely use of reperfusion therapy, and the effects of reperfusion on mortality.
RESULTS: In total, 755 patients had suspected STEMI. Median time to presentation was 105 minutes (IQR, 60-235 minutes). Reperfusion therapy was used in 66.9% of patients (505/755), and timely reperfusion therapy in 23.1% (174/755). Thombolysis was administered in 39.2% of those who received reperfusion therapy (198/505), while 60.8% (307/505) received primary percutaneous intervention. Cardiac arrest (OR, 2.83; P = 0.001) and treatment under the auspices of a cardiology unit (OR, 2.14; P = 0.02) were associated with use of reperfusion therapy. A normal electrocardiogram on presentation (OR, 0.42; P = 0.01), left bundle branch block (OR, 0.18; P = 0.001), acute pulmonary oedema (OR, 0.34; P < 0.01), history of diabetes (OR, 0.54; P < 0.01), and previous lesion on angiogram of > 50% (OR, 0.51; P = 0.001) were associated with not using reperfusion. In hospital mortality was 4.0% (30/755), mortality at 30 days was 4.8% (36/755), and mortality at 1 year was 7.8% (59/755). Receiving reperfusion therapy of any kind was associated with decreased 12-month mortality (hazard ratio [HR], 0.44; 95% CI, 0.25-0.78; P < 0.01). Timely reperfusion was associated with a reduction in mortality of 78% (HR, 0.22; P = 0.04). There were no significant differences in early and late mortality in rural patients compared with metropolitan patients (P = 0.66).
CONCLUSION: Timely reperfusion, not the modality of reperfusion, was associated with significant outcome benefits. Australian use of timely or any reperfusion remains poor and incomplete.
Luan T Huynh; Jamie M Rankin; Phil Tideman; David B Brieger; Matthew Erickson; Andrew J Markwick; Carolyn Astley; David J Kelaher; Derek P B Chew
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The Medical journal of Australia     Volume:  193     ISSN:  0025-729X     ISO Abbreviation:  Med. J. Aust.     Publication Date:  2010 Nov 
Date Detail:
Created Date:  2010-11-01     Completed Date:  2010-12-23     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0400714     Medline TA:  Med J Aust     Country:  Australia    
Other Details:
Languages:  eng     Pagination:  496-501     Citation Subset:  IM    
Flinders University, Adelaide, SA, Australia.
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MeSH Terms
Angioplasty, Balloon, Coronary / statistics & numerical data*
Australia / epidemiology
Bundle-Branch Block / epidemiology
Cardiology Service, Hospital
Diabetes Mellitus / epidemiology
Heart Arrest / epidemiology,  therapy
Hospital Mortality
Middle Aged
Myocardial Infarction / mortality*,  therapy*
Patient Selection
Prospective Studies
Pulmonary Edema / epidemiology
Rural Population
Stroke / epidemiology
Thrombolytic Therapy / statistics & numerical data*
Time Factors
Urban Population
Comment In:
Med J Aust. 2010 Nov 1;193(9):493-5   [PMID:  21034380 ]

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