Reperfusion therapy for ST-elevation acute myocardial infarction in Eastern Europe: the ISACS-TC registry
Por:
Cenko, E, Ricci, B, Kedev, S, Vasiljevic, Z, Dorobantu, M, Gustiene, O, Knezevic, B, Milicic, D, Dilic, M, Trninic, D, Smith, F, Manfrini, O, Badimon, L, Bugiardini, R
Publicada:
1 ene 2016
Resumen:
Aims Widespread availability of tertiary hospitals with catheterization facilities, although vigorously promoted, has yet to become a reality in many countries with economy in transition. We sought to evaluate the clinical profile and mortality of patients who were hospitalized with a diagnosis of ST-segment elevation myocardial infarction (STEMI)and either received reperfusion therapy or remained without reperfusion in Eastern Europe.
Methods and results Data were obtained from the International Survey of Acute Coronary Syndromes in Transitional Countries (ISACS-TC; NCT01218776) on STEMI patients admitted to 57 hospitals in Eastern European countries from January 2010 to February 2015. The primary endpoint was 30-day mortality. Of 7982 patients, 65 (0.8%) had a documented contraindication to reperfusion, 5973 (75.5%) received fibrinolysis (n = 1032) or underwent primary percutaneous coronary intervention (p-PCI; n = 4941), and 1944 patients (24.6%) did not receive any reperfusion therapy. The overall un-adjusted 30-day mortality rate was 7.9%. Thirty-day mortality rates were higher in non-reperfusion patients (16.0 vs. 5.0% in the p-PCI group and 7.4% in fibrinolysis group). The strongest factors associated with not attempting reperfusion therapy among these patients were female sex (OR 1.29 CI 1.07-1.56), age (OR 1.02; CI 1.01-1.03), prior MI (OR 1.79; CI 1.38-2.32), prior cerebrovascular events (OR 1.87; CI 1.30-2.68), chronic kidney disease (OR 1.76; CI 1.22-2.53), Killip class.1 (OR 1.31; CI 1.06-1.62), and time to admission >12 h (OR 15.9; CI 13.1-19.3).
Conclusions A substantial number of patients are still not offered any reperfusion therapy in many Eastern European countries with economy in transition, and this was associated with increased 30-day mortality. Time from symptoms onset to admission >12 h was the highest ranking among factors related to lack of reperfusion therapy. Quality improvement efforts should focus on minimizing delay to hospital admission among STEMI patients.
Filiaciones:
Cenko, E:
Univ Bologna, Dept Expt Diagnost & Specialty Med, Via Massarenti 9, I-40138 Bologna, Italy
Ricci, B:
Univ Bologna, Dept Expt Diagnost & Specialty Med, Via Massarenti 9, I-40138 Bologna, Italy
Kedev, S:
Univ St Cyril & Methodius, Univ Clin Cardiol, Med Fac, Skopje, North Macedonia
Vasiljevic, Z:
Univ Belgrade, Clin Ctr Serbia, Belgrade, Serbia
Dorobantu, M:
Univ Med & Pharm Carol Davila, Bucharest, Romania
Floreasca Emergency Hosp, Dept Cardiol & Internal Med, Bucharest, Romania
Gustiene, O:
Lithuanian Univ Hlth Sci, Dept Cardiol, Kaunas, Lithuania
Knezevic, B:
Clin Ctr Montenegro, Ctr Cardiol, Podgorica, Montenegro
Milicic, D:
Univ Zagreb, Univ Hosp Ctr Zagreb, Dept Cardiovasc Dis, Zagreb, Croatia
Dilic, M:
Clin Ctr Univ Sarajevo, Sarajevo, Bosnia & Herceg
Trninic, D:
Clin Ctr Banja Luka, Republika Srpska, Bosnia & Herceg
Smith, F:
Univ Leeds, Leeds, W Yorkshire, England
Manfrini, O:
Univ Bologna, Dept Expt Diagnost & Specialty Med, Via Massarenti 9, I-40138 Bologna, Italy
Badimon, L:
Autonomous Univ Barcelona, CiberObn Inst Carlos III, Hosp Santa Creu & St Pau, Cardiovasc Res Ctr,CSIC ICCC, Barcelona, Spain
Bugiardini, R:
Univ Bologna, Dept Expt Diagnost & Specialty Med, Via Massarenti 9, I-40138 Bologna, Italy
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