Angioplasty within 24 h after thrombolysis in patients with acute ST-elevation myocardial infarction: current use, predictors and outcome. Results of the MITRA plus registry.
BACKGROUND
Percutaneous coronary intervention (PCI) early after thrombolysis (early PCI) in patients with ST-elevation myocardial infarction (STEMI) is currently advised by clinical guidelines, but little is known about its use in clinical practice.


METHODS
We analysed the MITRA (Maximal Individual Therapy of Acute Myocardial Infarction) plus registry.


RESULTS
Out of a total of 34276 patients with STEMI, 10600 (30.9%) were treated with intravenous thrombolysis. Out of these patients, 487 (4.6%) patients received an angioplasty between 61 min and 24 hours after thrombolysis. They were compared to 10113 (95.4%) patients who received PCI either later than 24 hours after thrombolysis or not at all. A continuous increase in the frequency of early PCI between the years 1994 (2%)-2002 (16.7%) was observed. After adjusting for confounding variables independent predictors to use early PCI were the increasing year of inclusion, the facility of the hospital to perform PCI, younger age and male gender. Hospital mortality was 7.2% in patients receiving early PCI, compared to 11.2% in the other group (<0.01). Independent predictors for a higher hospital mortality were shock, age >65 years, female gender, an anterior STEMI and a prehospital delay of >3 hours. However, early PCI was not longer associated with a lower mortality (OR 0.95, 95% CI 0.64-1.14).


CONCLUSIONS
Early PCI after thrombolysis is used infrequently in current clinical practice in Germany. Especially 'low risk' patients were treated with an early PCI, which may contribute to the missing effect on mortality compared to no or late PCI after thrombolysis.
Koeth
Oliver
O
Department of Cardiology, Herzzentrum Ludwigshafen, Klinikum Ludwigshafen, Bremserstr. 79, 67063 Ludwigshafen am Rhein, Germany. oliver-koeth@web.de
Bauer
Timm
T
Wienbergen
Harm
H
Gitt
Anselm Kai
AK
Juenger
Claus
C
Zeymer
Uwe
U
Hauptmann
Karl Eugen
KE
Glunz
Hans Georg
HG
Sechtem
Udo
U
Senges
Jochen
J
Zahn
Ralf
R
D015906:Angioplasty, Balloon, Coronary / Q000706:statistics & numerical data*; D005260:Female; D005858:Germany / Q000453:epidemiology; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy*; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012042:Registries; D015912:Thrombolytic Therapy / Q000379:methods / Q000706:statistics & numerical data*; D013997:Time Factors; D016896:Treatment Outcome