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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 angiography 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 groups, 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.

Place of publishing:

Kraków

Level of degree:

2 - studia doktoranckie

Degree discipline:

choroby układu krążenia

Degree grantor:

Uniwersytet Jagielloński. Collegium Medicum. Wydział Lekarski.

Promoter:

Dariusz Dudek

Date issued:

2011

Format:

application/pdf

Identifier:

oai:dl.cm-uj.krakow.pl:3455

Call number:

ZB-116989

ControlNumberVIRTUA:

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Language:

pol

Access rights:

tylko w bibliotece

Location of original object:

Biblioteka Medyczna Uniwersytetu Jagiellońskiego- Collegium Medicum

Object collections:

Last modified:

Oct 21, 2019

In our library since:

Mar 7, 2013

Number of object content hits:

3

Number of object content views in PDF format

3

All available object's versions:

http://dl.cm-uj.krakow.pl:8080/publication/3455

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Edition name Date
ZB-116989 Oct 21, 2019

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