Universal reperfusion therapy can be implemented: lessons from 20 years of management of patients admitted within 6 hours of symptom onset with ST-segment elevation acute myocardial infarction.
OBJECTIVE
To describe longitudinal trends in patients' characteristics, management and hospital outcomes over 20 years of therapy for ST-segment elevation myocardial infarction (STEMI).


METHODS
From 1988 to 2007, 2100 consecutive patients with STEMI were admitted within 6 hours of symptom onset to a centre with a systematic reperfusion policy. The population was divided into three periods 1988-1996, 1996-2001 and 2001-2007.


RESULTS
The baseline risk of mortality increased over time (p=0.02). Use of primary PCI increased and the proportion not receiving reperfusion therapy decreased (from 11.4 to 4.2%, p=0.0001). Adjunctive use of stents and glycoprotein IIb/IIIa antagonists increased. The proportion of patients achieving acute TIMI-3 flow in the infarct artery increased (81 to 92%, p=0.001), while time from symptom onset to reperfusion decreased (240 to 205 min, p<0.0001). This was associated with a decrease in age- and sex-adjusted in-hospital mortality from 8.9 to 7.7% and eventually 5.4% (p<0.01). However, the mortality of patients with cardiogenic shock was unaffected (76, 62 and 61%, respectively, p=0.18).


CONCLUSIONS
Reperfusion therapy can be implemented in up to 96% of STEMI patients admitted within 6 hours of symptom onset and this is associated with improvements in outcomes. Further improvements are needed in the management of patients with cardiogenic shock.
Juliard
Jean-Michel
JM
Centre hospitalier Bichat-Claude-Bernard, AP-HP, 46, 75018 Paris, France. jean-michel.juliard@bch.aphp.fr
Golmard
Jean-Louis
JL
Ducrocq
Gregory
G
Himbert
Dominique
D
Aubry
Pierre
P
Garbarz
Eric
E
Benamer
Hakim
H
Boudvillain
Olivier
O
Tchétché
Didier
D
Feldman
Laurent J
LJ
Burnod
Alexis
A
Greffet
Agnès
A
Lapostolle
Frédéric
F
Steg
Philippe Gabriel
PG
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D003326:Coronary Circulation; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D011787:Quality of Health Care / Q000706:statistics & numerical data; D018570:Risk Assessment; D012770:Shock, Cardiogenic / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D015607:Stents; D016019:Survival Analysis; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
D010975:Platelet Aggregation Inhibitors