open access

Vol 64, No 6 (2006)
Other
Published online: 2006-06-27
Submitted: 2012-12-28
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Original article
Treatment of acute ST-segment elevation myocardial infarction in West Pomerania province of Poland. Comparison between primary coronary intervention and thrombolytic therapy

Tomasz Dryja, Zdzisława Kornacewicz-Jach, Jarosław Gorący, Krzysztof Przybycień, Łukasz Jodko, Andrzej Skowronek, Michał Kurowski, Elżbieta Zinka
Kardiol Pol 2006;64(6):590-599.

open access

Vol 64, No 6 (2006)
Other
Published online: 2006-06-27
Submitted: 2012-12-28

Abstract

Introduction: The majority of randomised studies on reperfusion in acute ST-segment elevation myocardial infarction (STEMI) show the advantage of primary percutaneous coronary intervention (PCI) over thrombolysis. However, the real world registers’ data are not so unequivocal. Aim: To evaluate the way acute STEMI is treated in West Pomerania province with emphasis on comparison of two reperfusion strategies, primary PCI vs thrombolytic therapy, in early and long-term perspective. Methods: Medical records of 961 STEMI patients treated between 1 January 2003 and 31 December 2003 were analysed. Data were collected from 3 centres with emergency cath lab availability and 15 regional sites. Long-term mortality was assessed based on regional provincial office database data. Results: 69.9% of the study group received reperfusion (44.6% primary PCI, 25.3% thrombolysis). Mean age of patients was 62 (21 to 91) years. Patients referred for PCI were younger compared to the thrombolysis group. The percentage of females was similar in both groups. The majority of patients treated with PCI or thrombolysis were admitted to the hospital between 2 and 6 hours after symptoms - 268 patients (46.4%). Seventy-nine patients (8.3%) died in the early (30-day) period. Mean age at time of death was 73 ±8 years, whereas survivors’ age was 61.5 (±12) years (p <0.001). Significantly higher mortality was observed in the conservative treatment group (12.7%) compared to patients treated with reperfusion. Forty-two out of 662 patients treated with PCI and thrombolysis died. The group of thrombolytic therapy tended to have higher mortality (7.9%) than PCI patients (5.5%); the difference however was not significant. Early mortality was influenced by older age (73.4 vs 59.5), female gender, low ejection fraction, and previous myocardial infarction. Current smoking has a positive effect on survival (mortality rate in smokers was 2.6%, in non-smokers 8.2%; p=0.0001). In long-term follow-up overall mortality in the entire group of 961 patients was 15.7% (12.1% in the reperfusion group). Long-term prognosis was worsened by older age, low ejection fraction, diabetes mellitus and non-smoking. Conclusions: Treatment of STEMI in West Pomerania province is similar to that used in Europe and the USA. No significant difference in 30-day and long-term mortality between the two types of reperfusion were seen.

Abstract

Introduction: The majority of randomised studies on reperfusion in acute ST-segment elevation myocardial infarction (STEMI) show the advantage of primary percutaneous coronary intervention (PCI) over thrombolysis. However, the real world registers’ data are not so unequivocal. Aim: To evaluate the way acute STEMI is treated in West Pomerania province with emphasis on comparison of two reperfusion strategies, primary PCI vs thrombolytic therapy, in early and long-term perspective. Methods: Medical records of 961 STEMI patients treated between 1 January 2003 and 31 December 2003 were analysed. Data were collected from 3 centres with emergency cath lab availability and 15 regional sites. Long-term mortality was assessed based on regional provincial office database data. Results: 69.9% of the study group received reperfusion (44.6% primary PCI, 25.3% thrombolysis). Mean age of patients was 62 (21 to 91) years. Patients referred for PCI were younger compared to the thrombolysis group. The percentage of females was similar in both groups. The majority of patients treated with PCI or thrombolysis were admitted to the hospital between 2 and 6 hours after symptoms - 268 patients (46.4%). Seventy-nine patients (8.3%) died in the early (30-day) period. Mean age at time of death was 73 ±8 years, whereas survivors’ age was 61.5 (±12) years (p <0.001). Significantly higher mortality was observed in the conservative treatment group (12.7%) compared to patients treated with reperfusion. Forty-two out of 662 patients treated with PCI and thrombolysis died. The group of thrombolytic therapy tended to have higher mortality (7.9%) than PCI patients (5.5%); the difference however was not significant. Early mortality was influenced by older age (73.4 vs 59.5), female gender, low ejection fraction, and previous myocardial infarction. Current smoking has a positive effect on survival (mortality rate in smokers was 2.6%, in non-smokers 8.2%; p=0.0001). In long-term follow-up overall mortality in the entire group of 961 patients was 15.7% (12.1% in the reperfusion group). Long-term prognosis was worsened by older age, low ejection fraction, diabetes mellitus and non-smoking. Conclusions: Treatment of STEMI in West Pomerania province is similar to that used in Europe and the USA. No significant difference in 30-day and long-term mortality between the two types of reperfusion were seen.
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Keywords

acute myocardial infarction; management; coronary angioplasty; thrombolysis

About this article
Title

Original article
Treatment of acute ST-segment elevation myocardial infarction in West Pomerania province of Poland. Comparison between primary coronary intervention and thrombolytic therapy

Journal

Kardiologia Polska (Polish Heart Journal)

Issue

Vol 64, No 6 (2006)

Pages

590-599

Published online

2006-06-27

Bibliographic record

Kardiol Pol 2006;64(6):590-599.

Keywords

acute myocardial infarction
management
coronary angioplasty
thrombolysis

Authors

Tomasz Dryja
Zdzisława Kornacewicz-Jach
Jarosław Gorący
Krzysztof Przybycień
Łukasz Jodko
Andrzej Skowronek
Michał Kurowski
Elżbieta Zinka

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