Timely reperfusion in myocardial infarction associated with significant benefits

January 01, 0001

Timely reperfusion in myocardial infarction associated with significant benefits

The aim of this study was to describe the contemporary management and outcomes of patients presenting with ST-segment-elevation myocardial infarction (STEMI) in Australia. It consisted of an observational analysis of data for patients who presented with suspected STEMI and enrolled in the Australian Acute Coronary Syndrome Prospective Audit from 1 November 2005 to 31 July 2007. In total, 755 patients had suspected STEMI.

Median time to presentation was 105 minutes. Reperfusion therapy was used in 66.9% of patients, and timely reperfusion therapy in 23.1%. Thombolysis was administered in 39.2% of those who received reperfusion therapy, while 60.8% received primary percutaneous intervention. Cardiac arrest and treatment under the auspices of a cardiology unit were associated with use of reperfusion therapy. A normal electrocardiogram on presentation, left bundle branch block, acute pulmonary oedema, history of diabetes and previous lesion on angiogram of greater than 50% were associated with not using reperfusion. Inhospital mortality was 4.0%, mortality at 30 days was 4.8% and mortality at 1 year was 7.8%. Receiving reperfusion therapy of any kind was associated with decreased 12-month mortality (hazard ratio, HR: 0.44). Timely reperfusion was associated with a reduction in mortality of 78%. There were no significant differences in early and late mortality in rural patients compared with metropolitan patients.

The researchers concluded: "Timely reperfusion, not the modality of reperfusion, was associated with significant outcome benefits. Australian use of timely or any reperfusion remains poor and incomplete."

Time is of the essence.

For the full abstract, click here.

MJA 193(09):496-501, 1 November 2010
© The Medical Journal of Australia 2010
Reperfusion therapy in the acute management of ST-segment-elevation myocardial infarction in Australia: findings from the ACACIA registry. Luan T Huynh, Jamie M Rankin, Phil Tideman et al. Correspondence to Luan Huynh: luan.huynh@health.sa.gov.au

Category: K. Circulatory. Keywords: reperfusion, therapy, myocardial infarction, ST segment, elevation, myocardial infarction, observational analysis of data, registry, journal watch.
Synopsis edited by Dr Stephen Wilkinson, Melbourne, Australia. Posted on Global Family Doctor 19 November 2010

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