[ln-hospital mortality after ST-segment elevation myocardial infarction according to reperfusion therapy].
BACKGROUND
Primary angioplasty is considered the best reperfusion therapy in the treatment of ST-segment elevation myocardial infarction (STEMI). However, thrombolysis is the reperfusion method most commonly used, due to its wide availability, reduced costs and ease of administration.


OBJECTIVE
To compare in-hospital mortality in STEMI patients according to reperfusion therapy.


METHODS
Patients admitted to Chilean hospitals participating in the GEMI network, from 2001 to 2005, with STEMI were included. They were divided in three groups: a) treated with thrombolytics, b) treated with primary angioplasty, c) without reperfusion procedure. In-hospital mortality according to gender, was analyzed in each group, using a logistic regression method, to assess risk factors associated with mortality.


RESULTS
We included 3,255 patients. Global mortality was 9.9% (7.5% in men and 16.7% in women, p<0.001). Mortality in patients treated with thrombolytics, was 10.2% (7.6% in men and 18.7% in women, p<0.01). The figure for patients treated with primary angioplasty, was 4.7% (2.5% in men and 13% in women, p<0.01), and in patients without reperfusion, was 11.6% (9.8% in men and in 15.4% women, p<0.01). In each group women were older, had a higher prevalence of hypertension and a higher percentage of Killip 3-4 infarctions. Logistic regression showed that angioplasty, compared with no reperfusion, was associated with a reduced mortality only in men. The use of thrombolytics in women was associated with a higher mortality.


CONCLUSIONS
Primary angioplasty was the reperfusion therapy associated to the lower mortality in STEMI. Use of thrombolytics in women was associated with a higher mortality rate than in non reperfused women.
Prieto
Juan Carlos
JC
Centro Cardiovascular Hospital Clínico, Programa de Farmacología Molecular y Clínica, Instituto de Ciencias Biomédicas (ICBM), Universidad de Chile, Santiago, Chile. jprieto@med.uchile.cl
Sanhueza
Consuelo
C
Martínez
Nicolás
N
Nazzal
Carolina
C
Corbalán
Ramón
R
Cavada
Gabriel
G
Lanas
Fernando
F
Bartolucci
Jorge
J
Campos
Pabla
P
D015906:Angioplasty, Balloon, Coronary / Q000401:mortality*; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality* / Q000628:therapy; D012307:Risk Factors; D012737:Sex Factors; D013300:Streptokinase / Q000627:therapeutic use; D015912:Thrombolytic Therapy / Q000401:mortality*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D016896:Treatment Outcome
D005343:Fibrinolytic Agents; D013300:Streptokinase; D010959:Tissue Plasminogen Activator