Document Detail


Trends in reperfusion therapy of ST segment elevation myocardial infarction in Switzerland: six year results from a nationwide registry.
MedLine Citation:
PMID:  15958354     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To document the trends in reperfusion therapy for ST segment elevation myocardial infarction (STEMI) in Switzerland.
DESIGN: National prospective multicentre registry, AMIS Plus (acute myocardial infarction and unstable angina in Switzerland), of patients admitted with acute coronary syndromes.
SETTING: 54 hospitals of varying size and capability in Switzerland.
PATIENTS: 7098 of 11 845 AMIS Plus patients who presented with ST segment elevation or left bundle branch block on the ECG at admission.
MAIN OUTCOME MEASURES: In-hospital mortality and its predictors at admission by multivariate analysis.
RESULTS: The proportion of patients treated by primary percutaneous coronary intervention (PCI) progressively increased from 1997 to 2002, while the proportion with thrombolysis or no reperfusion decreased (from 8.0% to 43.1%, from 47.2% to 25.6%, and from 44.8% to 31.4%, respectively). Overall in-hospital mortality decreased over the study period from 12.2% to 6.7% (p < 0.001). Main in-hospital mortality predictors by multivariate analysis were primary PCI (odds ratio (OR) 0.52, 95% confidence interval (CI) 0.33 to 0.81), thrombolysis (OR 0.63, 95% CI 0.47 to 0.83), and Killip class III (OR 3.61, 95% CI 2.49 to 5.24) and class IV (OR 5.97, 95% CI 3.51 to 10.17) at admission. When adjusted for the year, multivariate analysis did not show PCI to be significantly superior to thrombolysis for in-hospital mortality (OR 1.2 for PCI better, 95% CI 0.8 to 1.9, p = 0.42).
CONCLUSION: Primary PCI has become the preferred mode of reperfusion for STEMI since 2002 in Switzerland, whereas use of intravenous thrombolysis has decreased from 1997 to 2002. Furthermore, there was a major reduction of in-hospital mortality over the same period.
Authors:
A-A Fassa; P Urban; D Radovanovic; N Duvoisin; J-M Gaspoz; J-C Stauffer; P Erne;
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Publication Detail:
Type:  Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Heart (British Cardiac Society)     Volume:  91     ISSN:  1468-201X     ISO Abbreviation:  Heart     Publication Date:  2005 Jul 
Date Detail:
Created Date:  2005-06-16     Completed Date:  2005-08-17     Revised Date:  2013-06-09    
Medline Journal Info:
Nlm Unique ID:  9602087     Medline TA:  Heart     Country:  England    
Other Details:
Languages:  eng     Pagination:  882-8     Citation Subset:  AIM; IM    
Affiliation:
Cardiovascular Department, La Tour Hospital, Avenue Maillard 1, 1217 Geneva, Switzerland.
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MeSH Terms
Descriptor/Qualifier:
Aged
Angina, Unstable / mortality,  physiopathology,  therapy
Cardiopulmonary Resuscitation
Female
Hospital Mortality
Hospitalization
Humans
Male
Middle Aged
Multivariate Analysis
Myocardial Infarction / mortality,  physiopathology,  therapy*
Myocardial Reperfusion / methods,  trends*
Prospective Studies
Registries
Switzerland / epidemiology
Thrombolytic Therapy / methods
Treatment Outcome
Comments/Corrections

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