Percutaneous coronary intervention and 1 year survival in patients treated with fibrinolytic therapy for acute ST-elevation myocardial infarction

• Published in: European heart journal Vol. 26; no. 6; pp. 544 - 548
• Main Authors: McClelland, Anthony J.J., Owens, Colum G., Walsh, Simon J., McCarty, David, Mathew, Thomas, Stevenson, Mike, Gracey, Helen, Khan, Mazhar M., Adgey, A.A. Jennifer
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01.03.2005; Oxford Publishing Limited (England)
• Subjects: Aged; Angioplasty, Balloon, Coronary; Biological and medical sciences; Cardiology. Vascular system; Combined Modality Therapy; Coronary heart disease; Female; Fibrinolytic Agents - therapeutic use; Fibrinolytic therapy; Heart; Humans; Logistic Models; Male; Medical sciences; Middle Aged; Myocardial Infarction - drug therapy; Myocardial Infarction - mortality; Myocardial Infarction - therapy; Myocarditis. Cardiomyopathies; Primary percutaneous coronary intervention; ST-elevation myocardial infarction; Survival Rate; Treatment Outcome; Human; Myocardial infarction; ST-elevation myocardial infarction; Prognosis; Fibrinolytic therapy; Angioplasty; Acute; Coronary artery; Instrumentation therapy; Primary percutaneous coronary intervention; Cardiovascular disease; Myocardial disease; Survival; ST elevation; Heart disease; Primary; Fibrinolytic
• ISSN: 0195-668X; 1522-9645
• DOI: 10.1093/eurheartj/ehi149

Aims To assess the predictors of 1 year mortality in patients treated with fibrinolytic therapy for ST-segment elevation myocardial infarction (STEMI) and to determine whether a strategy of early percutaneous coronary intervention (PCI) improves outcome. Methods and results Consecutive patients (n=474) admitted to our unit (1998–2001) with STEMI were treated with fibrinolytic therapy. For each patient, age, gender, admission via mobile coronary care unit (MCCU), infarct location, initial systolic blood pressure and Killip class, prior history of ischaemic heart disease, hypertension, diabetes mellitus, smoking status, family history, hyperlipidaemia, and in-hospital PCI (n=154) were recorded. Mortality at 1 year was obtained from medical records (n=473). Binary logistic regression analysis was performed to determine independent predictors of 1 year mortality. Mortality in the non-PCI group was 21 vs. 7% in the PCI group. Independent predictors of 1 year mortality were age (risk ratio 1.12, 95% CI 1.08–1.15, P<0.0001), initial SBP≤80 mmHg (risk ratio 4.34, 95% CI 1.68–11.2, P=0.002), initial Killip class ≥3 (risk ratio 2.97, 95% CI 1.42–6.2, P=0.004), and lack of in-hospital PCI (risk ratio 0.39, 95% CI 0.19–0.81, P=0.012). Although the PCI group were younger (P=0.007), more likely to be admitted via the MCCU (P=0.008), with a shorter pain to needle time (P=0.04), multivariable analysis adjusted for these differences. Conclusion In-hospital PCI in patients treated with fibrinolytic therapy for STEMI is associated with a substantial reduction in 1 year mortality.