Which factors are associated with the application of reperfusion therapy in ST-elevation acute coronary syndromes?. Lessons from the Euro Heart Survey on Acute Coronary Syndromes I.

Abstract

BACKGROUND/AIMS:

A large proportion of patients with a ST-elevation acute coronary syndrome do not receive reperfusion therapy. In order to contribute to a better understanding of the clinical decision making process, we analyzed which factors are associated with the application of reperfusion therapy.

METHODS:

From the Euro Heart Survey of Acute Coronary Syndromes I, 4,260 patients with ST-elevation acute coronary syndrome were selected for the current analysis, of which 1,539 (36%) patients received fibrinolysis and 904 (21%) primary percutaneous coronary intervention (PCI). The analysis contained 32 variables on demographics, medical history, admission parameters and reperfusion therapy.

RESULTS:

A short pre-hospital delay, arrival in a hospital with PCI facilities, severe ST-elevation, and participation in a clinical trial were the strongest predictors for receiving reperfusion therapy. Primary PCI was more likely to be performed than fibrinolysis in patients with a long pre-hospital delay, arriving in a hospital with PCI facilities, not participating in a clinical trial, and with at least one previous PCI.

CONCLUSION:

Hospital facilities and culture, pre-hospital delay and infarction size play a major role in management decisions regarding reperfusion therapy in ST-elevation acute coronary syndrome. This analysis indicates which factors require special attention when implementing and reviewing the reperfusion guidelines.

• Authors: R Nieuwlaat, M Lenzen, H J G M Crijns, M H Prins, W J Scholte op Reimer, A Battler, D Hasdai, N Danchin, A K Gitt, M L Simoons, E Boersma
• Journal: Cardiology (Cardiology) Vol. 106 Issue 3 Pg. 137-46 ( 2006) ISSN: 0008-6312 [Print] Switzerland
• PMID: 16636543 (Publication Type: Journal Article)
• Copyright: Copyright 2006 S. Karger AG, Basel.

Topics

• Aged
• Coronary Disease (physiopathology, therapy)
• Electrocardiography
• Female
• Humans
• Male
• Middle Aged
• Myocardial Reperfusion
• Practice Patterns, Physicians'