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    Trends in acute reperfusion therapy for ST-segment elevation myocardial infarction from 1999 to 2006: we are getting better but we have got a long way to go

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    Authors
    Eagle, Kim A.
    Nallamothu, Brahmajee K.
    Mehta, Rajendra H.
    Granger, Christopher B.
    Steg, Phillippe Gabriel
    Van de Werf, Frans
    Lopez-Sendon, Jose
    Goodman, Shaun G.
    Quill, Ann L.
    Fox, Keith A. A.
    UMass Chan Affiliations
    Department of Surgery
    Center for Outcomes Research
    Document Type
    Journal Article
    Publication Date
    2008-03-04
    Keywords
    Aged
    Angioplasty, Balloon, Coronary
    Bundle-Branch Block
    Combined Modality Therapy
    Electrocardiography
    Epidemiologic Methods
    Female
    Hospital Mortality
    Humans
    Male
    Middle Aged
    Myocardial Infarction
    Myocardial Reperfusion
    Thrombolytic Therapy
    Health Services Research
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    Link to Full Text
    http://dx.doi.org/10.1093/eurheartj/ehn069
    Abstract
    AIM: Many patients who are eligible for acute reperfusion therapy receive it after substantial delays or not at all. We wanted to determine whether over the years more patients are receiving reperfusion therapy. METHODS AND RESULTS: This analysis is based on 10 954 patients with ST elevation or left bundle-branch block presenting within 12 h of symptom onset and enrolled in the GRACE registry between April 1999 and June 2006. Over this time, there was an increasing trend in use of primary percutaneous coronary intervention (PCI) from 15% to 44% (P < 0.001), while use of fibrinolytic therapy decreased (from 41 to 16%; P < 0.01). No trend in median time to primary PCI was seen but that for fibrinolysis declined significantly (from 40 to 34%; P < 0.0001). Hospital mortality declined (6.9-5.4%; P < 0.01); the relationship between observed and expected mortality improved over time (P = 0.06). Nevertheless, 33% of patients still received no reperfusion therapy. Factors associated with reperfusion use included age; prior myocardial infarction, heart failure or coronary artery bypass graft surgery; history of diabetes; female sex; and delay from symptom onset to hospital arrival. In 2006, 52% of patients receiving fibrinolysis had door-to-needle times >30 min and 42% of those undergoing primary PCI had door-to-balloon times >90 min. CONCLUSION: Primary PCI is now used much more than fibrinolysis. Although hospital mortality and delays to fibrinolytic reperfusion have improved, over 40% of patients reperfused still receive it outside the time window recommended, and one-third of potentially eligible patients receive no reperfusion.
    Source
    Eur Heart J. 2008 Mar;29(5):609-17. Link to article on publisher's site
    DOI
    10.1093/eurheartj/ehn069
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/27216
    PubMed ID
    18310671
    Related Resources
    Link to Article in PubMed
    ae974a485f413a2113503eed53cd6c53
    10.1093/eurheartj/ehn069
    Scopus Count
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    GRACE Publications

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