title: Primary percutaneous coronary intervention and thrombolysis improve survival in patients with ST-elevation myocardial infarction and pre-hospital resuscitation.
abstract: BACKGROUND
  Patients with ST-elevation myocardial infarction (STEMI) surviving pre-hospital resuscitation represent a selected subgroup of patients with a very high adverse event rate. Only few data on the outcome of primary percutaneous coronary intervention (primary PCI) and thrombolysis in such patients are available.
  
  
  METHODS
  We analysed the Maximal Individual Therapy of Acute Myocardial Infarction (MITRA) Plus registry. 1529 survivors of pre-hospital resuscitation with STEMI were included. 593 (38.8%) of those patients did not receive early reperfusion therapy, 793 (51.9%) patients received thrombolysis and 143 (9.4%) patients received primary PCI. Hospital mortality in patients receiving primary PCI or thrombolysis was adjusted for confounding factors with a propensity score analysis.
  
  
  RESULTS
  Primary PCI as well as thrombolysis in survivors of pre-hospital resuscitation with STEMI were associated with a significant reduction of hospital mortality (OR: 0.29, 95% CI 0.17-0.50; and 0.74, 95% CI 0.54-0.99, respectively), while primary PCI was superior compared to thrombolysis (OR 0.50, 95% CI 0.30-0.84).
  
  
  CONCLUSIONS
  Reperfusion therapy improves mortality of patients with STEMI surviving pre-hospital resuscitation, while primary PCI seems to be more effective than thrombolysis.
authors.affiliation: Herzzentrum Ludwigshafen, Department of Cardiology, Ludwigshafen, Germany. koetho@kiliu.de
authors.forename: Oliver
authors.initials: O
authors.lastname: Koeth
authors.forename: Ralf
authors.initials: R
authors.lastname: Zahn
authors.forename: Timm
authors.initials: T
authors.lastname: Bauer
authors.forename: Claus
authors.initials: C
authors.lastname: Juenger
authors.forename: Anselm Kai
authors.initials: AK
authors.lastname: Gitt
authors.forename: Jochen
authors.initials: J
authors.lastname: Senges
authors.forename: Uwe
authors.initials: U
authors.lastname: Zeymer
mesh_terms: D000368:Aged; D016887:Cardiopulmonary Resuscitation; D016009:Chi-Square Distribution; D003131:Combined Modality Therapy; D005260:Female; D005858:Germany / Q000453:epidemiology; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy*; D015425:Myocardial Reperfusion / Q000379:methods*; D011446:Prospective Studies; D012008:Recurrence; D020521:Stroke / Q000401:mortality; D015996:Survival Rate; D015912:Thrombolytic Therapy / Q000379:methods*; D016896:Treatment Outcome