Trends in acute reperfusion therapy for ST-segment elevation myocardial infarction from 1999 to 2006: we are getting
Kim A Eagle1, Brahmajee K Nallamothu, Rajendra H Mehta
1University of Michigan Cardiovascular Center, Ann Arbor, MI 48109-0477, USA. keagle@umich.edu
European Heart Journal
|March 4, 2008
Summary
Despite improvements in reperfusion therapy for ST-elevation myocardial infarction, many eligible patients still experience delays or receive no treatment. Primary percutaneous coronary intervention (PCI) use increased, but timely reperfusion remains a challenge.
Area of Science:
- Cardiology
- Interventional Cardiology
- Acute Coronary Syndromes
Background:
- Acute reperfusion therapy is crucial for ST-elevation myocardial infarction (STEMI) patients.
- Substantial delays and undertreatment persist, impacting patient outcomes.
Purpose of the Study:
- To analyze trends in reperfusion therapy utilization and timing over time.
- To assess changes in hospital mortality and treatment delays in STEMI patients.
Main Methods:
- Analysis of 10,954 STEMI patients from the GRACE registry (April 1999 - June 2006).
- Evaluation of trends in primary percutaneous coronary intervention (PCI) and fibrinolytic therapy use.
- Assessment of door-to-needle and door-to-balloon times, and hospital mortality.
Main Results:
- Primary PCI use increased significantly (15% to 44%), while fibrinolysis decreased (41% to 16%).
- Median time to fibrinolysis declined, but no trend was observed for primary PCI.
- Hospital mortality decreased, yet one-third of eligible patients received no reperfusion therapy.
Conclusions:
- Primary PCI has become the dominant reperfusion strategy over fibrinolysis.
- Despite improved mortality and reduced fibrinolysis delays, many patients still receive delayed reperfusion or no treatment.
- Significant delays in door-to-needle and door-to-balloon times persist, highlighting ongoing challenges in acute reperfusion care.
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