title: 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.
abstract: 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.
authors.affiliation: Department of Cardiology, Herzzentrum Ludwigshafen, Klinikum Ludwigshafen, Bremserstr. 79, 67063 Ludwigshafen am Rhein, Germany. oliver-koeth@web.de
authors.forename: Oliver
authors.initials: O
authors.lastname: Koeth
authors.forename: Timm
authors.initials: T
authors.lastname: Bauer
authors.forename: Harm
authors.initials: H
authors.lastname: Wienbergen
authors.forename: Anselm Kai
authors.initials: AK
authors.lastname: Gitt
authors.forename: Claus
authors.initials: C
authors.lastname: Juenger
authors.forename: Uwe
authors.initials: U
authors.lastname: Zeymer
authors.forename: Karl Eugen
authors.initials: KE
authors.lastname: Hauptmann
authors.forename: Hans Georg
authors.initials: HG
authors.lastname: Glunz
authors.forename: Udo
authors.initials: U
authors.lastname: Sechtem
authors.forename: Jochen
authors.initials: J
authors.lastname: Senges
authors.forename: Ralf
authors.initials: R
authors.lastname: Zahn
mesh_terms: 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