open access

Vol 66, No 2 (2008)
Other
Published online: 2008-03-03
Submitted: 2012-12-28
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Original article
Short- and long-term mortality in patients with ST-elevation myocardial infarction treated with different therapeutic strategies. Results from WIelkopolska REgional 2002 Registry (WIRE Registry)

Stefan Grajek, Maciej Lesiak, Aleksander Araszkiewicz, Małgorzata Pyda, Włodzimierz Skorupski, Marek Grygier, Przemysław Mitkowski, Marek Prech, Artur Baszko, Magdalena Janus, Piotr Bręborowicz, Janusz Rzeźniczak, Janusz Tarchalski, Andrzej Główka, Andrzej Cieśliński
Kardiol Pol 2008;66(2):154-163.

open access

Vol 66, No 2 (2008)
Other
Published online: 2008-03-03
Submitted: 2012-12-28

Abstract


Backround:

Although primary coronary angioplasty seems to be the best treatment in acute myocardial infarction (MI), thrombolytic therapy still remains the most common reperfusion strategy particularly in smaller centers. Nowadays, different regional networks are developed to improve the treatment of patients with MI.
Aim:

To analyse the effects of different therapeutic strategies on 30-day and long-term mortality (median time 18.3 months) after ST-elevation MI (STEMI) in a population of 3 350 000 people from the Wielkopolska Region.
Methods:

In 2002, 3780 patients with STEMI entered the registry. Complete data were available for 3564 (94.3%) patients. Depending on therapeutic strategies, patients were divided into five groups: the PCI group &#8211; direct percutaneous coronary angioplasty (PCI) in small cathlab, &#8216;selected patients&#8217;, n=381 (10.7%); the PA group &#8211; aged <70, treated with tissue plasminogen activator (rt-PA) up to 4 hours from the onset of chest pain, n=479 (13.4%); the IS group &#8211; invasive strategy in every patient, 24-hour duty, setting of unselected patients with STEMI, n=989 (27.7%); the SK group &#8211; patients receiving standard streptokinase treatment up to 12 hours from the onset of chest pain, n=584 (16.4%); the NR group &#8211; no reperfusion therapy, n=1131 (31.7%).
Results:

The 30-day mortality rate in the groups above was: 3.15, 4.38, 4.54, 9.25, and 12.5% respectively (p <0.001). Long-term mortality rate was: 4.2, 9.4, 9.4, 14.4, and 18.50% respectively (p <0.001). The rate of urgent PCI in the PA group was 25% and in the SK group &#8211; 11% (p <0.001).
Conclusions:

Treatment with rt-PA in patients under 70 years of age and up to 4 hours from pain onset may be an alternative to an invasive strategy. However, a quarter of those patients require urgent PCI. In long-term observation the mortality benefit can be clearly seen only in patients with early PCI.

Abstract


Backround:

Although primary coronary angioplasty seems to be the best treatment in acute myocardial infarction (MI), thrombolytic therapy still remains the most common reperfusion strategy particularly in smaller centers. Nowadays, different regional networks are developed to improve the treatment of patients with MI.
Aim:

To analyse the effects of different therapeutic strategies on 30-day and long-term mortality (median time 18.3 months) after ST-elevation MI (STEMI) in a population of 3 350 000 people from the Wielkopolska Region.
Methods:

In 2002, 3780 patients with STEMI entered the registry. Complete data were available for 3564 (94.3%) patients. Depending on therapeutic strategies, patients were divided into five groups: the PCI group &#8211; direct percutaneous coronary angioplasty (PCI) in small cathlab, &#8216;selected patients&#8217;, n=381 (10.7%); the PA group &#8211; aged <70, treated with tissue plasminogen activator (rt-PA) up to 4 hours from the onset of chest pain, n=479 (13.4%); the IS group &#8211; invasive strategy in every patient, 24-hour duty, setting of unselected patients with STEMI, n=989 (27.7%); the SK group &#8211; patients receiving standard streptokinase treatment up to 12 hours from the onset of chest pain, n=584 (16.4%); the NR group &#8211; no reperfusion therapy, n=1131 (31.7%).
Results:

The 30-day mortality rate in the groups above was: 3.15, 4.38, 4.54, 9.25, and 12.5% respectively (p <0.001). Long-term mortality rate was: 4.2, 9.4, 9.4, 14.4, and 18.50% respectively (p <0.001). The rate of urgent PCI in the PA group was 25% and in the SK group &#8211; 11% (p <0.001).
Conclusions:

Treatment with rt-PA in patients under 70 years of age and up to 4 hours from pain onset may be an alternative to an invasive strategy. However, a quarter of those patients require urgent PCI. In long-term observation the mortality benefit can be clearly seen only in patients with early PCI.
Get Citation

Keywords

myocardial infarction mortality; thrombolysis; primary angioplasty

About this article
Title


Original article
Short- and long-term mortality in patients with ST-elevation myocardial infarction treated with different therapeutic strategies. Results from WIelkopolska REgional 2002 Registry (WIRE Registry)

Journal

Kardiologia Polska (Polish Heart Journal)

Issue

Vol 66, No 2 (2008)

Pages

154-163

Published online

2008-03-03

Bibliographic record

Kardiol Pol 2008;66(2):154-163.

Keywords

myocardial infarction mortality
thrombolysis
primary angioplasty

Authors

Stefan Grajek
Maciej Lesiak
Aleksander Araszkiewicz
Małgorzata Pyda
Włodzimierz Skorupski
Marek Grygier
Przemysław Mitkowski
Marek Prech
Artur Baszko
Magdalena Janus
Piotr Bręborowicz
Janusz Rzeźniczak
Janusz Tarchalski
Andrzej Główka
Andrzej Cieśliński

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