Reperfusion strategy for ST-segment elevation myocardial infarction: trend over a 10-year period
1Department of Medicine, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong. wukwokleung@hotmail.com
Insights
Primary percutaneous coronary intervention is increasingly replacing thrombolytic therapy for ST-segment elevation myocardial infarction. However, many patients still do not receive reperfusion due to factors like delayed presentation.
Area of Science:
- Cardiology
- Interventional Cardiology
- Public Health
Background:
- ST-segment elevation myocardial infarction (STEMI) requires timely reperfusion.
- Historically, thrombolytic therapy was the primary reperfusion strategy.
- The advent of primary percutaneous coronary intervention (PCI) has shifted treatment paradigms.
Purpose of the Study:
- To analyze the 10-year trend of reperfusion strategies for STEMI.
- To assess the adoption of PCI versus thrombolytic therapy.
- To identify reasons for the non-receipt of reperfusion therapy in STEMI patients.
Main Methods:
- A case series design was employed.
- Data were collected from a regional hospital in Hong Kong.
- Patient records from January 2000 to December 2009 were reviewed.
Main Results:
- Primary PCI use increased significantly from 1.6% in 2000 to 30.6% in 2009.
- Thrombolytic therapy use decreased from 57.4% to 35.0% during the same period.
- Delayed presentation (45.1%) was the most common reason for no reperfusion.
Conclusions:
- Primary PCI is increasingly the preferred reperfusion strategy for STEMI.
- Thrombolytic therapy remains a significant, though declining, treatment option.
- Addressing barriers to reperfusion, such as delayed presentation, is crucial.
Abstract:
OBJECTIVES. To review the 10-year trend of reperfusion strategies in patients with ST-segment elevation myocardial infarction, and the adoption rate of percutaneous coronary interventions as opposed to thrombolytic therapy. Also to explore why some patients did not receive reperfusion therapy, and document changes in reperfusion strategies after the introduction of primary percutaneous coronary intervention programmes. DESIGN. Case series. SETTING. A regional hospital, Hong Kong. PATIENTS. All patients with ST-segment elevation myocardial infarction from January 2000 to December 2009. RESULTS. There were 1835 patients with ST-segment elevation myocardial infarction in that period, of which 1179 (64.3%) received reperfusion therapy (thrombolytic therapy, 46.0%; primary percutaneous coronary intervention, 17.5%; emergency coronary artery bypass graft, 0.7%). After introduction of the primary percutaneous coronary intervention programme, significantly more ST-segment elevation myocardial infarction cases underwent that particular intervention (1.6% in 2000 increasing to 30.6% in 2009), while the proportion receiving thrombolytic therapy declined (57.4% in 2000 decreasing to 35.0% in 2009). Seven reasons for no reperfusion therapy were identified. The commonest ones were delayed presentation (45.1%), succumbed before reperfusion (16.0%), multiple medical co-morbidities (15.2%), and contra-indication to thrombolytic therapy (14.8%). The proportion without reperfusion therapy due to a contra-indication to thrombolytic therapy declined (22.7% in 2000 decreasing to 4.9% to 2009), whilst an increasing proportion received primary percutaneous coronary interventions. CONCLUSIONS. Primary percutaneous coronary intervention is increasingly used as the reperfusion therapy in ST-segment elevation myocardial infarction and is replacing thrombolytic therapy, though the latter still remains a mainstay of therapy. A significant proportion of ST-segment elevation myocardial infarction cases received no reperfusion due to various reasons.
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