title: Characteristics and Clinical Course of STEMI Patients who Received no Reperfusion in the Australia and New Zealand SNAPSHOT ACS Registry.
abstract: BACKGROUND
  Cohort studies of STEMI patients have reported that over 30% receive no reperfusion. Barriers to greater use of reperfusion in STEMI patients require further elucidation.
  
  
  METHODS
  We collected data on STEMI patients with no reperfusion as part of the SNAPSHOT ACS Registry, which recruited consecutive ACS patients in 478 hospitals throughout Australia and New Zealand during 14-27 May 2012.
  
  
  RESULTS
  Of 4387 patients enrolled, 419 were diagnosed with STEMI. Primary PCI (PPCI) was performed in 160 (38.2%), fibrinolysis was used in 105 (25.1%), and 154 (36.7%) had no reperfusion. Patients with no reperfusion had a mean age of 70.3±15.0 years compared with 63.1±13.5 in the reperfusion group (p<0.0001). There were more females in the no reperfusion group (37.1% v 23.0% p=0.002) and they were significantly more likely to have prior PCI or CABG, heart failure, atrial fibrillation, chronic kidney disease and other vascular disease, and to be nursing home residents (all p<0.05). Patients without reperfusion had a significantly higher mortality in hospital (11.7% v 4.9%, p=0.011). In 370 patients who presented within 12hours, 28 had early angiography without PCI, which was considered an attempt at reperfusion. Therefore reperfusion was attempted in 293 of 370 eligible patients (79.2%).
  
  
  CONCLUSIONS
  Of consecutive STEMI patients, 36.7% did not receive any reperfusion and they had a higher risk of death in hospital. In eligible patients, reperfusion was attempted in 79.2%. National strategies to encourage earlier medical contact and greater use of reperfusion in eligible patients may lead to better outcomes.
authors.affiliation: Department of Cardiology, Canberra Hospital and the Australian National University, Canberra, ACT, Australia. Electronic address: afarshid@tpg.com.au.
authors.forename: Ahmad
authors.initials: A
authors.lastname: Farshid
authors.affiliation: Department of Cardiology, Concord Hospital and University of Sydney, Sydney, NSW, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Brieger
authors.affiliation: The George Institute for Global Health, Sydney, NSW, Australia.
authors.forename: Karice
authors.initials: K
authors.lastname: Hyun
authors.affiliation: Department of Cardiology, Royal Brisbane and Women's Hospital, Brisbane, Qld, Australia.
authors.forename: Christopher
authors.initials: C
authors.lastname: Hammett
authors.affiliation: Department of Cardiology, Auckland City Hospital, Auckland, New Zealand.
authors.forename: Christopher
authors.initials: C
authors.lastname: Ellis
authors.affiliation: Department of Cardiology, Fiona Stanley Hospital, Perth, WA, Australia.
authors.forename: Jamie
authors.initials: J
authors.lastname: Rankin
authors.affiliation: Department of Cardiology, Royal Melbourne Hospital, Melbourne, Vic, Australia.
authors.forename: Jeff
authors.initials: J
authors.lastname: Lefkovits
authors.affiliation: Department of Cardiovascular Medicine, Flinders Medical Centre and Flinders University, Adelaide, SA, Australia.
authors.forename: Derek
authors.initials: D
authors.lastname: Chew
authors.affiliation: Department of Cardiology, Liverpool Hospital and University of New South Wales, Sydney, NSW, Australia.
authors.forename: John
authors.initials: J
authors.lastname: French
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D006333:Heart Failure / Q000209:etiology / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000601:surgery; D015425:Myocardial Reperfusion / Q000009:adverse effects*; D009520:New Zealand / Q000453:epidemiology; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects*; D011183:Postoperative Complications / Q000401:mortality*; D012042:Registries; D051436:Renal Insufficiency, Chronic / Q000209:etiology / Q000401:mortality; D015996:Survival Rate
keywords: Primary percutaneous coronary intervention; Reperfusion therapy; ST elevation myocardial infarction; Thrombolysis