title: Effectiveness of a change in reperfusion strategy to primary percutaneous coronary intervention in a nonselected population.
abstract: BACKGROUND
  Randomized controlled trials have established the clinical superiority of primary percutaneous coronary intervention (PCI) over fibrinolysis for ST segment elevation myocardial infarction (STEMI) in selected populations. However, the clinical effectiveness of the primary PCI strategy with modern adjunctive antiplatelet therapy deserves further evaluation.
  
  
  OBJECTIVE
  To validate results from randomized controlled trials in a nonselected Canadian population.
  
  
  METHODS
  A retrospective study of 243 consecutive patients who presented with a STEMI at a single academic centre was performed. Baseline characteristics, treatment strategies and in-hospital outcomes of patients treated in 2004 to 2005 (n=129) were compared with those of patients treated in 1999 to 2000 (n=114). Logistic regression was used to adjust for imbalanced baseline characteristics.
  
  
  RESULTS
  Patients in the 2004 to 2005 cohort versus those in the 1999 to 2000 cohort were older and more likely to be hypertensive and to present in Killip class 2 to 4. All of the patients treated in 2004 to 2005 underwent a primary PCI strategy compared with 32.5% in the 1999 to 2000 cohort. The in-hospital incidence of death, reinfarction or stroke was reduced from 21.9% in 1999 to 2000, to 15.5% in 2004 to 2005 (adjusted OR 0.462; P=0.055), largely due to a reduction in reinfarction (10.5% to 3.1%, adjusted OR 0.275; P=0.041). In-hospital mortality and stroke rates did not change significantly. The median length of stay was reduced from eight to six days in the recent cohort (P=0.002).
  
  
  CONCLUSIONS
  In the present nonselected population, the change in reperfusion strategy from fibrinolysis to primary PCI in the treatment of STEMI reduced the length of hospitalization by two days and was associated with an adjusted 54% relative reduction in adverse in-hospital events, which was largely due to a significant reduction in reinfarction.
authors: Division of General Cardiology, Centre hospitalier de l'Université de Montréal, Montréal, Québec, Canada.
authors: Alexis
authors: A
authors: Matteau
authors: Marc
authors: M
authors: Dorais
authors: Stéphane
authors: S
authors: Rinfret
authors: Jacques
authors: J
authors: LeLorier
authors: Francois
authors: F
authors: Reeves
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D002170:Canada; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy / Q000628:therapy*; D015425:Myocardial Reperfusion; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D015912:Thrombolytic Therapy; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors