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Title: Treatment strategy assessment in patients with acute myocardialinfarction in municipal hospital before and after the introduction of24/7 primary PCI service
Abstract:
Background: The introduction of 24/7 primary PCI service increases theaccessibility of invasive diagnosis and improves the results of treatment of patientssuffering from acute coronary syndromes.Aim: The aim of the study was to analyse the characteristics of patients with acutemyocardial infarction with and without the ST-segment elevation (STEMI,NSTEMI) and the assessment of the effects of implementing various treatmentmethods in those groups (non-invasive treatment, reperfusion – lytic therapy,pharmacomechanical therapy), and also to establish the benefits of the introductionof the 24/7 primary PCI service.Methods: The analysis included in total 451 patients suffering from the acutecoronary syndrome. The enrollment continued for 12 months - period I (19.04.2004– 19.04.2005), before the introduction of the 24/7 primary PCI service and 15months – period II (8.08.2005 – 19.10.2006), after the introduction of the 24/7primary PCI service. The registered patients were divided into four groups: STEMIgroup in period I (n = 115), NSTEMI group in period I (n = 113), STEMI group inperiod II (n = 111), NSTEMI group in period II (n = 112). The STEMI patients inperiod I received non-invasive treatment (n = 59), facilitated PCI (n = 32) and lytics- streptokinase (n = 24), but during period II all the patients underwent the primaryPCI. The NSTEMI patients in period I underwent coronary angio ; graphy duringhospital stay and in period II received the early invasion treatment on the earlyinvasive strategy (coronary angiography was performed within 48 hours). All groupswere followed for 1 year.Results: The STEMI groups of patients received the following therapy – in period Iinvasive treatment 48,7% (facilitated PCI 27,8% and lytics 20,9%), in period II allpatients underwent primary PCI. The in-hospital mortality of the patients withSTEMI in period I receiving the non-invasive treatment was 23,7%. The STEMI Igroup with pharmacoinvasive approach had better outcome – the in-hospitalmortality was 9,4%, and in the group undergoing primary PCI (STEMI II) 5,4%. Thebenefit of invasive treatment was seen during 1-year of follow-up. The NSTEMIgroup of patients underwent PCI during hospital stay respectively 38,0% in period Iand 89,3% in period II. The patients of the NSTEMI group sub-classified as the highrisk patients according to the TIMI Risk Score (5 points and more) had worseprognosis in comparison to the sub-group of the low and intermediate risk (the inhospitaland 1-year mortality in period I were 3,6% vs 0,0%, p=0,15 and 10,9% vs3,5%, p=0,13, in period II respectively 3,8% vs 0,0%, p =0,13 and 9,4% vs 1,7%,p=0,07). The outcome of the high risk NSTEMI population was comparable withSTEMI patients group (the 1-year mortality rate is 9,0% vs 9,4%). The patients in ; both grou ; ps, STEMI and NSTEMI, in period II had shorter hospital stay. Theindependent predictors of 1-year mortality in the group of STEMI patients wereolder age and peripheral artery obstructive disease, and in the NSTEMI group femalegender and previous congestive heart failure.Conclusions: The introduction of the 24/7 primary PCI service increased theaccessibility of the invasive diagnosis and improved the results of the treatment ofpatients suffering from acute coronary syndrome. The 1-year mortality in the STEMIpatients and high risk NSTEMI group of patients, according to the TIMI Risk Score,was similar. The patients with STEMI treated invasively had better outcome.
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Last modified:
Mar 17, 2023
In our library since:
Mar 7, 2013
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3
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http://dl.cm-uj.krakow.pl:8080/publication/3455
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| Edition name | Date |
|---|---|
| ZB-116989 | Mar 17, 2023 |
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