Reperfusion Strategies and Outcomes of ST-Segment Elevation Myocardial Infarction Patients in Canada: Observations From the Global Registry of Acute Coronary Events (GRACE) and the Canadian Registry of Acute Coronary Events (CANRACE)
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Authors
Czarnecki, AndrewWelsh, Robert C.
Yan, Raymond T.
DeYoung, J. Paul
Gallo, Richard
Rose, Barry
Grondin, Francois R.
Kornder, Jan
Wong, Graham C.
Fox, Keith A. A.
Gore, Joel M.
Goodman, Shaun G.
Yan, Andrew T.
UMass Chan Affiliations
Department of Medicine, Division of Cardiovascular MedicineCenter for Outcomes Research
Document Type
Journal ArticlePublication Date
2012-01-02
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BACKGROUND: We examine the clinical characteristics and outcomes of ST-elevation myocardial infarction (STEMI) patients receiving various reperfusion therapies in 2 contemporary Canadian registries. METHODS: Of 4045 STEMI patients, 2024 received reperfusion therapy and had complete data on invasive management. They were stratified by reperfusion strategy used: primary percutaneous coronary intervention (PCI) (n =716); fibrinolysis with rescue PCI (n =177); fibrinolysis with urgent/elective PCI (n =210); and fibrinolysis without PCI (n =921). Data were collected on clinical and laboratory findings, and outcomes. RESULTS: Compared with fibrinolytic-treated patients, patients treated with primary PCI were younger and had higher Killip class, had longer time to delivery of reperfusion therapy, and utilized more antiplatelet therapy but less heparin, beta-blockers and angiotensin-converting enzyme inhibitors. In-hospital death occurred in 2.7% of patients treated with primary PCI, 1.7% fibrinolysis-rescue PCI, 1.0% fibrinolysis-urgent/elective PCI, and 4.8% fibrinolysis-alone (P =0.009); the rates of death/reinfarction were 3.9%, 4.0%, 4.3%, and 7.1% (P =0.032), respectively. The rate of shock was highest in the primary PCI group. Rates of heart failure or major bleeding were similar in the 4 groups. In multivariable analysis, no PCI during hospitalization was associated with death and reinfarction (adjusted odds ratio = 1.66; 95% confidence interval, 1.03-2.70; P =0.04). CONCLUSIONS: Clinical features, time to reperfusion, and medication utilization differed with respect to the reperfusion strategy. While low rates of re-infarction/death were observed, these complications occurred more frequently in those who did not undergo PCI during index hospitalization. Inc. All rights reserved.Source
Can J Cardiol. 2012 Jan;28(1):40-7. Epub 2011 Nov 29. Link to article on publisher's siteDOI
10.1016/j.cjca.2011.09.011Permanent Link to this Item
http://hdl.handle.net/20.500.14038/27280PubMed ID
22129488Related Resources
Link to Article in PubMedae974a485f413a2113503eed53cd6c53
10.1016/j.cjca.2011.09.011