Primary percutaneous intervention of ST-elevation myocardial infarction in Austria: Results from the Austrian acute PCI registry 2005-2007.
BACKGROUND
Primary percutaneous coronary intervention (PPCI) has become the preferred reperfusion strategy in ST-elevation myocardial infarction (STEMI). Implementation of networks of care and registries providing continuous quality assessment are key components for optimal management in patients with STEMI.


OBJECTIVE
To analyze procedural success and in-hospital outcome of interventional therapy of STEMI in Austria.


METHODS
We evaluated a total number of 4016 consecutive STEMI patients registered in the first three years after implementation of the Austrian acute PCI registry in January 2005.


RESULTS
The rate of PPCI as an indication for acute coronary intervention increased from 83.5% in 2005 to 92.4% in 2007 (P < 0.0001). During this period the median door-to-balloon time decreased from 60.0 (40.0-90.0) min to 53.0 (30.0-80.0) min (P = 0.012). The percentage of patients receiving adequate adjunctive antithrombotic therapy with ASA/heparin and clopidogrel significantly increased (78.8-85.1% and 67.8-90.3%, respectively; P < 0.001). Overall in-hospital mortality was 9.6% in rescue PCI, 6.4% in facilitated PCI and 5.1% in PPCI. On multivariate analysis, cardiogenic shock (OR: 20.21, 95% CI: 12.21-33.44, P < 0.001), resuscitation (OR: 2.62, 95% CI: 1.47-4.69, P = 0.01), age (OR: 1.04, 95% CI: 1.02-1.06, P < 0.001) and angiographic success (OR: 5.93, 95% CI: 3.33-10.57, P < 0.001) were independent predictors of in-hospital death.


CONCLUSIONS
Continuous nationwide efforts to establish regional networks for STEMI treatment in the years 2005-2007 led to a decrease in door-to-balloon time, improved adjunctive antithrombotic therapy and an in-hospital mortality of 5%. Results of interventional STEMI treatment in Austria are in accordance with current guidelines and with other contemporary registries.
Dörler
Jakob
J
Department of Internal Medicine III, Cardiology, Innsbruck Medical University, Innsbruck, Austria.
Alber
Hannes Franz
HF
Altenberger
Johann
J
Bonner
Gerhard
G
Benzer
Werner
W
Grimm
Georg
G
Huber
Kurt
K
Kaltenbach
Lalit
L
Pfeiffer
Karl-Peter
KP
Schuchlenz
Herwig
H
Siostrzonek
Peter
P
Zenker
Gerald
G
Pachinger
Otmar
O
Weidinger
Franz
F
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D001317:Austria; D003131:Combined Modality Therapy; D019058:Community Networks; D017023:Coronary Angiography; D004562:Electrocardiography; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data; D011379:Prognosis; D011785:Quality Assurance, Health Care / Q000706:statistics & numerical data; D012042:Registries; D013996:Time and Motion Studies
D005343:Fibrinolytic Agents