[ln-hospital mortality after ST-segment elevation myocardial infarction according to reperfusion therapy]
Juan Carlos Prieto1, Consuelo Sanhueza, Nicolás Martínez
1Centro Cardiovascular Hospital Clínico, Programa de Farmacología Molecular y Clínica, Instituto de Ciencias Biomédicas (ICBM), Universidad de Chile, Santiago, Chile. jprieto@med.uchile.cl
Insights
Primary angioplasty significantly reduces in-hospital mortality for ST-segment elevation myocardial infarction (STEMI) patients. Thrombolysis, however, showed increased mortality in women, highlighting the need for tailored reperfusion strategies.
Area of Science:
- Cardiology
- Emergency Medicine
- Clinical Research
Background:
- Primary angioplasty is the gold standard for ST-segment elevation myocardial infarction (STEMI) reperfusion.
- Thrombolysis remains prevalent due to accessibility, cost, and ease of administration.
Purpose of the Study:
- To compare in-hospital mortality rates among STEMI patients based on reperfusion therapy.
- To analyze mortality differences by gender within each treatment group.
Main Methods:
- Retrospective analysis of 3,255 STEMI patients from Chilean hospitals (2001-2005).
- Patients categorized into three groups: thrombolysis, primary angioplasty, or no reperfusion.
- Logistic regression used to assess mortality risk factors, including gender.
Main Results:
- Overall in-hospital mortality was 9.9%, with higher rates in women (16.7%) than men (7.5%).
- Primary angioplasty group had the lowest mortality (4.7%), while no reperfusion had the highest (11.6%).
- Angioplasty reduced mortality in men; thrombolysis increased mortality in women compared to no reperfusion.
Conclusions:
- Primary angioplasty is associated with the lowest in-hospital mortality in STEMI patients.
- Thrombolytic therapy in women with STEMI was linked to higher mortality compared to non-reperfusion.
- Gender-specific outcomes underscore the importance of reperfusion strategy selection.
Background:
Primary angioplasty is considered the best reperfusion therapy in the treatment of ST-segment elevation myocardial infarction (STEMI). However, thrombolysis is the reperfusion method most commonly used, due to its wide availability, reduced costs and ease of administration.
Aim:
To compare in-hospital mortality in STEMI patients according to reperfusion therapy.
Material And Methods:
Patients admitted to Chilean hospitals participating in the GEMI network, from 2001 to 2005, with STEMI were included. They were divided in three groups: a) treated with thrombolytics, b) treated with primary angioplasty, c) without reperfusion procedure. In-hospital mortality according to gender, was analyzed in each group, using a logistic regression method, to assess risk factors associated with mortality.
Results:
We included 3,255 patients. Global mortality was 9.9% (7.5% in men and 16.7% in women, p<0.001). Mortality in patients treated with thrombolytics, was 10.2% (7.6% in men and 18.7% in women, p<0.01). The figure for patients treated with primary angioplasty, was 4.7% (2.5% in men and 13% in women, p<0.01), and in patients without reperfusion, was 11.6% (9.8% in men and in 15.4% women, p<0.01). In each group women were older, had a higher prevalence of hypertension and a higher percentage of Killip 3-4 infarctions. Logistic regression showed that angioplasty, compared with no reperfusion, was associated with a reduced mortality only in men. The use of thrombolytics in women was associated with a higher mortality.
Conclusions:
Primary angioplasty was the reperfusion therapy associated to the lower mortality in STEMI. Use of thrombolytics in women was associated with a higher mortality rate than in non reperfused women.
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