Efficacy of a 24-h primary percutaneous coronary intervention service on outcome in patients with ST elevation myocardial infarction in clinical practice.
BACKGROUND
Primary percutaneous coronary intervention (PCI) for ST elevation myocardial infarction (STEMI) improves outcome in comparison to fibrinolysis. However, it is unclear whether patients treated in interventional facilities with 24-h primary PCI service have lower rates of adverse events.


METHODS
We analyzed data of consecutive patients with STEMI prospectively enrolled in the German Acute Coronary Syndromes registry between July 2000 and November 2002 who were admitted to hospitals with catheterisation laboratory.


RESULTS
Overall 6,350 patients were divided into two groups: 2,779 (43.8%) were treated in hospitals with and 3,571 (56.2%) without 24-h on-call cardiac catheter laboratories. 83.0% of the patients at facilities with and only 69.9% of the patients at facilities without 24-h PCI service received early reperfusion therapy (P < 0.001). Hospital death (7.4% vs. 9.9%, P < 0.001), non-fatal myocardial reinfarction (2.5% vs. 6.4%, P < 0.0001) and stroke (0.3 vs. 1.0%, P < 0.01) occurred significantly less often in patients treated in hospitals with 24-h primary PCI service. After adjustment for the confounding factors in the propensity score analysis the 24-h on-call strategy remained superior for the combined endpoint of death, reinfarction and stroke (OR 0.63, 95% CI 0.54-0.75).


CONCLUSIONS
In clinical practice the rate of patients receiving reperfusion therapy was significantly higher in hospitals with 24-h primary PCI service which was associated with an improved in-hospital outcome. Though the data was collected at a time that does not completely represent current clinical practice, these results could have an impact on planning efficient infarct networks in the future.
Bauer
Timm
T
Herzzentrum Ludwigshafen, Department of Cardiology, Medizinische Klinik B, Bremserstrasse 79, Ludwigshafen, Germany. bauer-timm@gmx.de
Hoffmann
Rainer
R
Jünger
Claus
C
Koeth
Oliver
O
Zahn
Ralf
R
Gitt
Anselm
A
Heer
Tobias
T
Bestehorn
Kurt
K
Senges
Jochen
J
Zeymer
Uwe
U
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D016507:Cardiology Service, Hospital / Q000458:organization & administration*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy*; D011446:Prospective Studies; D012042:Registries; D055502:Secondary Prevention; D020521:Stroke / Q000453:epidemiology / Q000209:etiology*; D013997:Time Factors; D016896:Treatment Outcome