title: Outcome up to one year following different reperfusion strategies in acute ST-segment elevation myocardial infarction: the Helsinki-Uusimaa Hospital District registry of ST-Elevation Acute Myocardial Infarction (HUS-STEMI).
abstract: OBJECTIVE
  Current guidelines prefer primary percutaneous coronary intervention (pPCI) over fibrinolysis in the treatment of acute ST-elevation myocardial infarction (STEMI). Pre-hospital fibrinolysis followed by early invasive evaluation is an alternative that we have used in patients presenting within three hours of symptom onset. We made a survey of patients suffering an acute STEMI over one year to assess mortality and adverse events following either pPCI or fibrinolysis.
  
  
  RESULTS
  Of the 448 consecutive STEMI patients, 194 were treated with pPCI and 176 underwent fibrinolysis; 78 patients received no reperfusion treatment within 12 hours (NRT group). The median TIMI risk scores were 4.0, 3.0 and 4.0 in the pPCI, fibrinolysis and NRT groups, respectively (p<0.001). Mortality at one year was 14.4% following pPCI, 5.1% following fibrinolysis and 12.8% in the NRT group (p=0.011 across all groups and p=0.003 between pPCI and fibrinolysis, adjusted for differences in risk factors). The one-year composite of cardiovascular death, stroke, reinfarction and new revascularization was 20.1%, 18.2% and 26.9% for the pPCI, fibrinolysis and NRT groups, respectively (p=NS). In patients presenting within three hours of symptom onset, one-year mortality was 3.7% in the fibrinolysis group (n=163) and 15.3% in the pPCI group (n=118) (adjusted p =0.001), while the composite of adverse events was 16.6% in the former group and 19.5% in the latter (p=NS).
  
  
  CONCLUSIONS
  Pre-hospital fibrinolysis followed by routine early invasive evaluation provides an excellent reperfusion strategy for low-risk STEMI patients presenting early after symptom onset.
authors: Department of Cardiology, Helsinki University Central Hospital, Finland.
authors: Juho
authors: J
authors: Viikilä
authors: Jyrki
authors: J
authors: Lilleberg
authors: Ilkka
authors: I
authors: Tierala
authors: Mikko
authors: M
authors: Syvänne
authors: Markku
authors: M
authors: Kupari
authors: Veikko
authors: V
authors: Salomaa
authors: Markku S
authors: MS
authors: Nieminen
mesh_terms: D000368:Aged; D004562:Electrocardiography; D005260:Female; D005387:Finland / Q000453:epidemiology; D005500:Follow-Up Studies; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006786:Hospitals, Urban; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D015425:Myocardial Reperfusion / Q000592:standards*; D011159:Population Surveillance / Q000379:methods*; D017410:Practice Guidelines as Topic / Q000592:standards*; D011446:Prospective Studies; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome
keywords: Myocardial infarction; fibrinolysis; primary angioplasty