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Kardiologia polska

Effect of introducing a regional 24/7 primary percutaneous coronary intervention service network on treatment outcomes in patients with ST segment elevation myocardial infarction.


PMID 25428812

Abstract

In patients with acute ST segment elevation myocardial infarction (STEMI), primary percutaneous coronary intervention (PCI) is the preferred reperfusion method over fibrinolysis, if it is performed in a timely fashion by an experienced team in a centre with on-site primary PCI service. Treatment delay due to patient transfer to the cardiac catheterisation laboratory is an important limitation of mechanical reperfusion in STEMI patients. To analyse treatment outcomes in STEMI patients hospitalised in a regional hospital in Tarnow before and after introduction of a 24/7 primary PCI service. Enrollment into the registry continued for 12 months before introduction of a 24/7 primary PCI service (Period I: 19.04.2004-19.04.2005) and 15 months after introduction of a 24/7 primary PCI service (Period II: 8.08.2005-19.10.2006). Overall, 226 STEMI patients were analysed, including 115 patients in Period I and 111 patients in Period II. STEMI patients in Period I received conservative treatment (n = 59), pharmacoinvasive treatment (a half dose of alteplase, a full dose of abciximab, and transfer to a 24/7 primary PCI reference centre: n = 32) or fibrinolysis with streptokinase (n = 24), while all patients in Period II underwent primary PCI on the first day of hospitalisation. Occurrence of cardiovascular deaths, non-fatal recurrent infarctions, and revascularisation with PCI or coronary artery bypass grafting was evaluated in the two groups during 1-year follow-up. Reperfusion therapy was used in 48.7% of STEMI patients in Period I (pharmacoinvasive treatment in 27.8% and fibrinolysis in 20.9%), and all patients in Period II underwent primary PCI. In-hospital mortality among STEMI patients in Period I was significantly higher than in Period II (23.5% vs. 5.4%, p < 0.001), and it was 23.7% in patients managed conservatively. The hazard ratio for Period II compared to Period I was 0.14 (95% CI 0.03-0.62, p = 0.009). A benefit of invasive treatment was seen during 1 year of follow-up (mortality 26.1% in Period I vs. 9.0% in Period II, p = 0.001). Invasive treatment was also associated with a shorter hospital stay. Introduction of a 24/7 primary PCI regional service (STEMI network) led to improved accessibility of invasive diagnosis and treatment and increased reperfusion treatment rates, resulting in reduced in-hospital and 1-year mortality among STEMI patients.