title: Primary angioplasty versus no reperfusion therapy in patients with acute myocardial infarction and a pre-hospital delay of > 12-24 hours: results from the pooled data of the maximal individual therapy in acute myocardial infarction (MITRA) registry and the myocardial infarction registry (MIR).
abstract: OBJECTIVE
  In patients with acute myocardial infarction (AMI), treatment with thrombolysis is superior to no reperfusion therapy only up to 12 hours after the onset of symptoms. There are no data addressing whether this time limit is also justified for treatment with primary angioplasty.
  
  
  METHODS
  The pooled data of two German ST-segment elevation AMI registries, the Maximal Individual Therapy in Acute Myocardial Infarction (MITRA) study and the Myocardial Infarction Registry (MIR), were analyzed.
  
  
  METHODS
  Out of 22,749 patients, eight hundred and forty-eight with a pre-hospital delay of > 12 hours and < or = 24 hours were treated with either primary angioplasty (94/848; 11.1%) or no reperfusion therapy (754/848; 88.9%).
  
  
  RESULTS
  Patients treated with primary angioplasty were 10 years younger (59 years versus 69 years; p = 0.001), more often male [72.3% versus 59.9%; odds ratio (OR) = 0.57; 95% confidence interval (CI) = 0.36-0.92] and less likely to be diabetics (17% versus 27.2%; OR = 0.55; 95% CI = 0.31-0.97). Hospital mortality was 8.5% in patients treated with primary angioplasty compared to 17.1% in patients with no reperfusion therapy (OR = 0.45; 95% CI = 0.21-0.95; p = 0.033) and the combined endpoint (death, reinfarction or stroke) occurred significantly less often (11.7% versus 20.3%; OR = 0.52; 95% CI =0.27-1; p = 0.045). However, multiple logistic regression showed only a non-significant trend for lower mortality (OR = 0.54; 95% CI =0.20-1.23) and the combined endpoint (OR = 0.65; 95% CI = 0.29-1.31) in patients treated with primary angioplasty.
  
  
  CONCLUSIONS
  These data show the possibility of a benefit of primary angioplasty over conservative treatment in patients with pre-hospital delays of > 12 up to 24 hours, although multiple logistic regression analysis failed to find significant differences between treatments. This might be due to inadequate study power or a selection bias. These findings encourage further investigation of this subject.
authors.affiliation: Herzzentrum Ludwigshafen, Dept. of Cardiology, Bremserstrasse 79, D-67063 Ludwigshafen, Germany. erzahn@aol.com
authors.forename: R
authors.initials: R
authors.lastname: Zahn
authors.forename: R
authors.initials: R
authors.lastname: Schiele
authors.forename: S
authors.initials: S
authors.lastname: Schneider
authors.forename: A K
authors.initials: AK
authors.lastname: Gitt
authors.forename: H
authors.initials: H
authors.lastname: Wienbergen
authors.forename: K
authors.initials: K
authors.lastname: Seidl
authors.forename: C
authors.initials: C
authors.lastname: Bossaller
authors.forename: G F
authors.initials: GF
authors.lastname: Hauf
authors.forename: M
authors.initials: M
authors.lastname: Gottwik
authors.forename: E
authors.initials: E
authors.lastname: Altmann
authors.forename: W
authors.initials: W
authors.lastname: Rosahl
authors.forename: J
authors.initials: J
authors.lastname: Senges
mesh_terms: D000367:Age Factors; D000368:Aged; D017130:Angioplasty / Q000401:mortality; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000601:surgery* / Q000628:therapy; D015995:Prevalence; D011446:Prospective Studies; D012042:Registries; D015424:Reperfusion / Q000401:mortality; D013997:Time Factors