title: Reperfusion strategies and outcomes of ST-segment elevation myocardial infarction patients in Canada: observations from the Global Registry of Acute Coronary Events (GRACE) and the Canadian Registry of Acute Coronary Events (CANRACE).
abstract: BACKGROUND
  We examine the clinical characteristics and outcomes of ST-elevation myocardial infarction (STEMI) patients receiving various reperfusion therapies in 2 contemporary Canadian registries.
  
  
  METHODS
  Of 4045 STEMI patients, 2024 received reperfusion therapy and had complete data on invasive management. They were stratified by reperfusion strategy used: primary percutaneous coronary intervention (PCI) (n = 716); fibrinolysis with rescue PCI (n = 177); fibrinolysis with urgent/elective PCI (n = 210); and fibrinolysis without PCI (n = 921). Data were collected on clinical and laboratory findings, and outcomes.
  
  
  RESULTS
  Compared with fibrinolytic-treated patients, patients treated with primary PCI were younger and had higher Killip class, had longer time to delivery of reperfusion therapy, and utilized more antiplatelet therapy but less heparin, β-blockers and angiotensin-converting enzyme inhibitors. In-hospital death occurred in 2.7% of patients treated with primary PCI, 1.7% fibrinolysis-rescue PCI, 1.0% fibrinolysis-urgent/elective PCI, and 4.8% fibrinolysis-alone (P = 0.009); the rates of death/reinfarction were 3.9%, 4.0%, 4.3%, and 7.1% (P = 0.032), respectively. The rate of shock was highest in the primary PCI group. Rates of heart failure or major bleeding were similar in the 4 groups. In multivariable analysis, no PCI during hospitalization was associated with death and reinfarction (adjusted odds ratio = 1.66; 95% confidence interval, 1.03-2.70; P = 0.04).
  
  
  CONCLUSIONS
  Clinical features, time to reperfusion, and medication utilization differed with respect to the reperfusion strategy. While low rates of re-infarction/death were observed, these complications occurred more frequently in those who did not undergo PCI during index hospitalization.
authors: Terrence Donnelly Heart Centre, Division of Cardiology, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
authors: Andrew
authors: A
authors: Czarnecki
authors: Robert C
authors: RC
authors: Welsh
authors: Raymond T
authors: RT
authors: Yan
authors: J Paul
authors: JP
authors: DeYoung
authors: Richard
authors: R
authors: Gallo
authors: Barry
authors: B
authors: Rose
authors: Francois R
authors: FR
authors: Grondin
authors: Jan M
authors: JM
authors: Kornder
authors: Graham C
authors: GC
authors: Wong
authors: Keith A A
authors: KA
authors: Fox
authors: Joel M
authors: JM
authors: Gore
authors: Shaun G
authors: SG
authors: Goodman
authors: Andrew T
authors: AT
authors: Yan
mesh_terms: D002170:Canada / Q000453:epidemiology; D018450:Disease Progression; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D015425:Myocardial Reperfusion / Q000379:methods / Q000592:standards*; D017060:Patient Satisfaction; D017410:Practice Guidelines as Topic; D012042:Registries; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D015912:Thrombolytic Therapy / Q000379:methods / Q000592:standards*; D016896:Treatment Outcome