Document Detail


The acute myocardial infarction with ST segment elevation Udine registry (Come-to-Udine): predictors of 3 years mortality.
MedLine Citation:
PMID:  19507312     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Background: Percutaneous coronary intervention (PCI) is considered the best treatment for acute myocardial infarction with ST segment elevation (STEMI), but it is difficult to deliver. Objectives: To report on long-term mortality predictors in a registry based on a 'hub and spoke' model, according to the initial strategy: thrombolysis followed or not by PCI, invasive strategy followed or not by primary PCI and no reperfusion. Methods and results: From May 2001 to June 2003, 514 patients (mean age 67 +/- 12) with STEMI onset less than 12 h (<24 h if pain ongoing) were enrolled, 34% transferred from spoke centers. Patients were stratified according to thrombolysis in myocardial infarction risk score (TRS) and to local high-risk criteria (LHRC, one of the following: contraindication to thrombolysis, cardiogenic shock, anterior or right ventricular location, ST segment elevation in > or =6 leads, Killip class >1 and previous STEMI). Mean TRS score was 4.0 and 53% of patients met LHRC. Thrombolysis was undertaken in 49% of patients, invasive strategy in 29% and no reperfusion in 22%. The latter had higher TRS (4.9) but only 40% met LHRC. Reperfusion time was significantly longer in patients who underwent PCI as compared with those who underwent thrombolysis (223 vs. 120 min, P < 0.0001). Patients in the thrombolysis group had better risk profiles and underwent emergency or elective revascularization within 30 days in 66% of cases. Overall, long-term mortality rate (36 months) was 23.3%. Both TRS and LHRC identified patients with higher mortality (43 and 32%, respectively). Multivariate analysis showed age, left ventricular ejection fraction and Killip class more than 1 to be significant predictors of mortality (P < 0.0001/P < 0.0001/P = 0.0103), whereas reperfusion strategy and time to treatment were not. Conclusion: An initial strategy of thrombolysis followed by emergency or elective PCI as appropriate is still an option in a setting in which limited resources are available. Decision-making based on risk scores and time from symptom onset lead to proper patient selection and even to foregoing reperfusion without affecting mortality.
Authors:
Guglielmo Bernardi; Antonio Di Chiara; Ilaria Armellini;
Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Journal of cardiovascular medicine (Hagerstown, Md.)     Volume:  10     ISSN:  1558-2027     ISO Abbreviation:  J Cardiovasc Med (Hagerstown)     Publication Date:  2009 Jun 
Date Detail:
Created Date:  2009-06-08     Completed Date:  2009-06-25     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101259752     Medline TA:  J Cardiovasc Med (Hagerstown)     Country:  United States    
Other Details:
Languages:  eng     Pagination:  474-84     Citation Subset:  IM    
Affiliation:
SOC di Cardiologia, Azienda Ospedaliero-Universitaria S. Maria della Misericordia, Udine, Italy.
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MeSH Terms
Descriptor/Qualifier:
Aged
Angioplasty, Transluminal, Percutaneous Coronary / mortality*
Combined Modality Therapy
Female
Health Care Rationing / organization & administration
Health Services Accessibility / organization & administration*
Hospitals, Community / organization & administration*
Humans
Italy / epidemiology
Kaplan-Meiers Estimate
Male
Middle Aged
Myocardial Infarction / mortality*,  therapy*
Patient Selection
Patient Transfer / organization & administration*
Proportional Hazards Models
Registries
Risk Assessment
Risk Factors
Thrombolytic Therapy / mortality*
Time Factors
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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