Primary coronary angioplasty in hospitals with and without surgery backup. MITI project investigators.
In the Myocardial Infarction Triage and Intervention (MITI) project, a registry of acute myocardial infarction, 1,062 patients were treated for acute myocardial infarction using primary coronary angioplasty. Of those, 470 (44%) received the procedure in hospitals without coronary surgery capability on-site. These patients were compared to 592 (56%) other patients treated in hospitals with on-site surgery. Most baseline characteristics of patients treated by primary angioplasty were similar in the two types of centers. ST segment elevation was present in 76% of patients; time from admission to angiography averaged 100 +/- 71 minutes (median 77 minutes). There was no difference in procedural success rate nor initial and long-term mortality rates in patients treated by primary angioplasty in the two types of hospitals. The mortality rate at discharge for patients treated by primary coronary angioplasty was 7% in both types of hospitals. In the subset of patients with ST segment elevation and no evidence of shock and no prior bypass surgery, 30 day mortality rates were 7% and 8% (p = 0.46), respectively. In a multivariable analysis of those factors influencing survival, age, a history of prior myocardial infarction, and anterior ST elevation but not the availability of on-site surgical backup, was associated with outcome. In summary, this observational study suggests that with appropriate patient selection, trained operators, and a provision for hospital transfer, primary coronary angioplasty can be accomplished in centers without on-site surgery with acceptable outcomes.
Weaver
W D
WD
Division of Cardiology, University of Washington, Seattle, USA.
Parsons
L
L
Every
N
N
D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D005240:Feasibility Studies; D005260:Female; D017052:Hospital Mortality; D006786:Hospitals, Urban; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy*; D010348:Patient Care Team; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000401:mortality; D012008:Recurrence; D015996:Survival Rate; D016896:Treatment Outcome; D014861:Washington