open access

Vol 64, No 10 (2006)
Other
Published online: 2006-10-31
Submitted: 2012-12-28
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Original article
Management of myocardial infarction with ST-segment elevation in district hospitals without catheterisation laboratory – Acute Coronary Syndromes Registry of Małopolska 2002-2003

Dariusz Dudek, Zbigniew Siudak, Marcin Kuta, Artur Dziewierz, Waldemar Mielecki, Tomasz Rakowski, Dawid Giszterowicz, Jacek S. Dubiel
Kardiol Pol 2006;64(10):1053-1060.

open access

Vol 64, No 10 (2006)
Other
Published online: 2006-10-31
Submitted: 2012-12-28

Abstract


Introduction: Early reperfusion therapy significantly reduces mortality and improves outcome in ST-elevation myocardial infarction (STEMI). Primary percutaneous intervention has been proven to be a better therapeutic option than fibrinolysis when it can be performed by an experienced team of interventional cardiologists, within 90 minutes from the first medical contact. Despite the publication of guidelines of the European and American Scientific Societies (ESC and ACC/AHA), treatment of patients with STEMI is far from the optimum. The registry is an effective and reliable method to estimate the quality of treatment and demographic and epidemiologic characteristics of the population of a given region.
Aim: To evaluate the therapeutic strategies of treatment of STEMI in district hospitals without a catheterisation laboratory in Małopolska.
Methods: 29 district hospitals from Cracow and Małopolska province participated in the Registry of Acute Coronary Syndromes in Małopolska. Finally, 2382 patients with an initial diagnosis of acute coronary syndrome were included. In 867 of them, STEMI was finally diagnosed.
Results: 75 years old, in 20% chest pain lasted longer than 12 hours, in 7% cardiogenic shock was diagnosed and 12% had contraindications for thrombolysis or were at increased risk of haemorrhagic complications). Fifteen percent of all 867 patients were transferred to the interventional cardiology centre (63% for primary PCI, 20% for facilitated PCI and the remaining 17% for rescue PCI). Fibrinolysis was applied in 21% of all patients with STEMI. In-hospital mortality rate was 14.3% in patients treated with fibrinolysis as compared to 15.9% in those treated conservatively. Multivariate logistic regression revealed that younger age (OR 0.93; 95% CI 0.91&#8211;0.95; p <0.0001), lack of diabetes (OR 0.54; 95% CI 0.30&#8211;0.98; p=0.04) and higher systolic blood pressure (OR 0.93; 95% CI 1.00&#8211;1.02; p=0.006) were independent factors predicting the referral of patients with STEMI for PCI. GP IIb/IIIa inhibitors were used in 5% of all patients and in 30% of those referred for PCI.
Conclusions: Only one in every 7 patients with STEMI is qualified for PCI. Patients transferred to the centre with PCI facilities are younger, have no diabetes or hypotension. The use of GP IIb/IIIa inhibitors is limited. There is a need to establish local networks of hospitals with 24-hour catheterisation laboratory availability to increase frequency and efficacy of reperfusion therapy, especially in regions far from centres of interventional cardiology.

Abstract


Introduction: Early reperfusion therapy significantly reduces mortality and improves outcome in ST-elevation myocardial infarction (STEMI). Primary percutaneous intervention has been proven to be a better therapeutic option than fibrinolysis when it can be performed by an experienced team of interventional cardiologists, within 90 minutes from the first medical contact. Despite the publication of guidelines of the European and American Scientific Societies (ESC and ACC/AHA), treatment of patients with STEMI is far from the optimum. The registry is an effective and reliable method to estimate the quality of treatment and demographic and epidemiologic characteristics of the population of a given region.
Aim: To evaluate the therapeutic strategies of treatment of STEMI in district hospitals without a catheterisation laboratory in Małopolska.
Methods: 29 district hospitals from Cracow and Małopolska province participated in the Registry of Acute Coronary Syndromes in Małopolska. Finally, 2382 patients with an initial diagnosis of acute coronary syndrome were included. In 867 of them, STEMI was finally diagnosed.
Results: 75 years old, in 20% chest pain lasted longer than 12 hours, in 7% cardiogenic shock was diagnosed and 12% had contraindications for thrombolysis or were at increased risk of haemorrhagic complications). Fifteen percent of all 867 patients were transferred to the interventional cardiology centre (63% for primary PCI, 20% for facilitated PCI and the remaining 17% for rescue PCI). Fibrinolysis was applied in 21% of all patients with STEMI. In-hospital mortality rate was 14.3% in patients treated with fibrinolysis as compared to 15.9% in those treated conservatively. Multivariate logistic regression revealed that younger age (OR 0.93; 95% CI 0.91&#8211;0.95; p <0.0001), lack of diabetes (OR 0.54; 95% CI 0.30&#8211;0.98; p=0.04) and higher systolic blood pressure (OR 0.93; 95% CI 1.00&#8211;1.02; p=0.006) were independent factors predicting the referral of patients with STEMI for PCI. GP IIb/IIIa inhibitors were used in 5% of all patients and in 30% of those referred for PCI.
Conclusions: Only one in every 7 patients with STEMI is qualified for PCI. Patients transferred to the centre with PCI facilities are younger, have no diabetes or hypotension. The use of GP IIb/IIIa inhibitors is limited. There is a need to establish local networks of hospitals with 24-hour catheterisation laboratory availability to increase frequency and efficacy of reperfusion therapy, especially in regions far from centres of interventional cardiology.
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Keywords

acute myocardial infarction with ST-segment elevation; acute coronary syndrome; percutaneous coronary intervention; fibrinolysis; registry

About this article
Title

Original article
Management of myocardial infarction with ST-segment elevation in district hospitals without catheterisation laboratory – Acute Coronary Syndromes Registry of Małopolska 2002-2003

Journal

Kardiologia Polska (Polish Heart Journal)

Issue

Vol 64, No 10 (2006)

Pages

1053-1060

Published online

2006-10-31

Bibliographic record

Kardiol Pol 2006;64(10):1053-1060.

Keywords

acute myocardial infarction with ST-segment elevation
acute coronary syndrome
percutaneous coronary intervention
fibrinolysis
registry

Authors

Dariusz Dudek
Zbigniew Siudak
Marcin Kuta
Artur Dziewierz
Waldemar Mielecki
Tomasz Rakowski
Dawid Giszterowicz
Jacek S. Dubiel

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