Effect of time to treatment and age on one year mortality in acute STEMI: difference between thrombolysis and primary percutaneous coronary intervention.
BACKGROUND
Although thrombolysis (THL) and primary percutaneous coronary intervention (PPCI) are two validated options in reperfusion algorithms for ST-elevation myocardial infarction (STEMI), recent papers seems to show that PPCI could be the best therapeutic option irrespective of the time to treatment (TT) and of the cardiovascular risk profile of the patient. The impact of TT and age on reperfusion strategies requires elucidation. The aim of this study was to analyze the effect of time to treatment and age on the 1-year mortality of patients presenting with STEMI, for each reperfusion strategy.


METHODS
The study population consisted in 794 patients directly admitted to the cardiological intensive care unit for STEMI < or =12 hours. The relationship between TT and 1-year mortality was studied using logistic regression models. The models were implemented on the overall population and on 3 different age groups: [<65 years]; [> or =65 and <75 years]; [> or =75 years] for patients undergoing THL (n=299) and for patients undergoing PPCI (n=495). There was no significant between-group difference in all-cause 1-year mortality for the patients [<65 years] and those [> or =65 and <75 years]. In contrast, the 1-year mortality was significantly higher in the patients [> or =75 years] undergoing THL (51.4 vs. 15.3%; p<0.001). The analysis of the curves of mortality suggests that 1- year mortality of patients with STEMI depend not only on reperfusion strategy but so on the time to treatment and on the age of the patients.


CONCLUSIONS
In STEMI, on a 1-year mortality criteria, PPCI is not always upper than THL, particularly for patients<65 years treated within the first two hours after symptoms onset. TT and age affects the results of the reperfusion strategies and must be still incorporated in the reperfusion algorithms of STEMI.
de Labriolle
A
A
Département de cardiologie, Centre Hospitalier Universitaire Tours, France. axel.deladriolle@gmail.com
Pacouret
G
G
Giraudeau
B
B
Fremont
B
B
Desveaux
B
B
Quilliet
L
L
Fauchier
L
L
Charbonnier
B
B
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D015906:Angioplasty, Balloon, Coronary; D003326:Coronary Circulation; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy*; D018579:Patient Selection; D011446:Prospective Studies; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D015912:Thrombolytic Therapy; D013997:Time Factors; D016896:Treatment Outcome