title: Efficacy of a 24-h primary percutaneous coronary intervention service on outcome in patients with ST elevation myocardial infarction in clinical practice.
abstract: 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.
authors.affiliation: Herzzentrum Ludwigshafen, Department of Cardiology, Medizinische Klinik B, Bremserstrasse 79, Ludwigshafen, Germany. bauer-timm@gmx.de
authors.forename: Timm
authors.initials: T
authors.lastname: Bauer
authors.forename: Rainer
authors.initials: R
authors.lastname: Hoffmann
authors.forename: Claus
authors.initials: C
authors.lastname: Jünger
authors.forename: Oliver
authors.initials: O
authors.lastname: Koeth
authors.forename: Ralf
authors.initials: R
authors.lastname: Zahn
authors.forename: Anselm
authors.initials: A
authors.lastname: Gitt
authors.forename: Tobias
authors.initials: T
authors.lastname: Heer
authors.forename: Kurt
authors.initials: K
authors.lastname: Bestehorn
authors.forename: Jochen
authors.initials: J
authors.lastname: Senges
authors.forename: Uwe
authors.initials: U
authors.lastname: Zeymer
mesh_terms: 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