title: 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: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.affiliation: University Hospital Maastricht, Maastricht, The Netherlands.
authors.forename: R
authors.initials: R
authors.lastname: Nieuwlaat
authors.forename: M
authors.initials: M
authors.lastname: Lenzen
authors.forename: H J G M
authors.initials: HJ
authors.lastname: Crijns
authors.forename: M H
authors.initials: MH
authors.lastname: Prins
authors.forename: W J
authors.initials: WJ
authors.lastname: Scholte op Reimer
authors.forename: A
authors.initials: A
authors.lastname: Battler
authors.forename: D
authors.initials: D
authors.lastname: Hasdai
authors.forename: N
authors.initials: N
authors.lastname: Danchin
authors.forename: A K
authors.initials: AK
authors.lastname: Gitt
authors.forename: M L
authors.initials: ML
authors.lastname: Simoons
authors.forename: E
authors.initials: E
authors.lastname: Boersma
mesh_terms: D000368:Aged; D003327:Coronary Disease / Q000503:physiopathology / Q000628:therapy*; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015425:Myocardial Reperfusion; D010818:Practice Patterns, Physicians'