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)

• Published in: Canadian journal of cardiology Vol. 28; no. 1; pp. 40 - 47
• Main Authors: Czarnecki, Andrew, MD, Welsh, Robert C., MD, Yan, Raymond T., MD, DeYoung, J. Paul, MD, Gallo, Richard, MD, Rose, Barry, MD, Grondin, Francois R., MD, Kornder, Jan M., MD, Wong, Graham C., MD, Fox, Keith A.A., MB, ChB, FRCP, Gore, Joel M., MD, Goodman, Shaun G., MD, MSc, Yan, Andrew T., MD
• Format: Journal Article
• Language: English
• Published: England Elsevier Inc 2012
• Subjects: Canada - epidemiology; Cardiovascular; Disease Progression; Electrocardiography; Female; Follow-Up Studies; Humans; Male; Middle Aged; Myocardial Infarction - epidemiology; Myocardial Infarction - physiopathology; Myocardial Infarction - therapy; Myocardial Reperfusion - methods; Myocardial Reperfusion - standards; Patient Satisfaction; Practice Guidelines as Topic; Registries; Retrospective Studies; Survival Rate - trends; Thrombolytic Therapy - methods; Thrombolytic Therapy - standards; Treatment Outcome; Canada
• ISSN: 0828-282X; 1916-7075
• DOI: 10.1016/j.cjca.2011.09.011

Abstract 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, β-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.