Outcomes of Patients With ST-Elevation Myocardial Infarction Receiving and Not Receiving Reperfusion Therapy: The Importance of Examining All Patients.
Hospitals treating patients with ST-elevation myocardial infarction (STEMI) may show good results with reperfusion treatment (fibrinolysis or primary percutaneous coronary intervention [PPCI]), but a comprehensive evaluation should factor in outcomes of patients with STEMI who do not receive reperfusion. We compared outcomes of patients receiving and not receiving reperfusion within a complete system of STEMI care by hospital type: PPCI centres, fibrinolysis centres, centres that only transfer for PPCI, and centres providing a mix of fibrinolysis and PPCI transfer.



All patients presenting to 82 Quebec hospitals with characteristic symptoms, a final diagnosis of acute myocardial infarction, and core-laboratory confirmed STEMI over two 6-month periods were studied.



Of the total 3731 patients with STEMI, 2918 (78.2%) received reperfusion treatment (81% PPCI, 19% fibrinolysis); 813 (21.8%) did not. For reperfusion-treated patients, 30-day mortality was 5.4% in PPCI centres, 5.4% in fibrinolysis centres, 6.9% in transfer PPCI centres, and 6.0% in mixed centres (P = 0.55). For untreated patients, 30-day mortality was 15.7% (PPCI centres), 16.1% (fibrinolysis centres), 21.8% (transfer PPCI), and 24.6% (mixed) (P = 0.08). Adjusted mortality odds ratios for all patients were 1.00 (PPCI centres), 1.50 (95% CI: 0.97-2.32; fibrinolysis centres), 1.30 (0.95-1.78; transfer PPCI centres), and 1.58 (1.09-2.29; mixed centres). PPCI was within recommended delays in 35.4%, 11.9%, and 1.2% of PPCI, transfer, and mixed centres, respectively.



Mixed centres had the highest crude and adjusted all-patient 30-day STEMI mortality. Relatively good outcomes of reperfusion-treated patients, despite long treatment delays, can misrepresent overall performance if untreated patients are not examined.
Unité d'évaluation cardiovasculaire, Institut national d'excellence en santé et en services sociaux (INESSS), Montreal, Québec, Canada. Electronic address: laurie.lambert@inesss.qc.ca.
Laurie J
LJ
Lambert
Division of Cardiology, Department of Medicine, McGill University Health Centre, Montreal, Québec, Canada.
James M
JM
Brophy
Department of Medicine, Montreal Heart Institute, Montreal, Québec, Canada.
Normand
N
Racine
Service de cardiologie, Département multidisciplinaire de cardiologie, Institut universitaire de cardiologie et de pneumologie de Québec, Québec City, Québec, Canada.
Stéphane
S
Rinfret
Department of Medicine, Montreal Heart Institute, Montreal, Québec, Canada.
Philippe L
PL
L'Allier
Unité d'évaluation cardiovasculaire, Institut national d'excellence en santé et en services sociaux (INESSS), Montreal, Québec, Canada.
Kevin A
KA
Brown
Unité d'évaluation cardiovasculaire, Institut national d'excellence en santé et en services sociaux (INESSS), Montreal, Québec, Canada.
Lucy J
LJ
Boothroyd
Corporation d'Urgences-santé, Montreal, Québec, Canada; Services préhospitaliers d'urgence en Montérégie, Longueuil, Québec, Canada; Département de médecine préhospitalière, Hôpital Sacré-Cœur de Montréal, Montreal, Québec, Canada.
Dave
D
Ross
Corporation d'Urgences-santé, Montreal, Québec, Canada; Emergency Department, Sir Mortimer B. Davis Jewish General Hospital, Montreal, Québec, Canada.
Eli
E
Segal
Service de cardiologie, Département de médecine spécialisée, Centre hospitalier régional de Lanaudière, Joliette, Québec, Canada.
Simon
S
Kouz
Service de médecine d'urgence et de médecine préhospitalière, Département de médecine d'urgence, Centre hospitalier affilié universitaire Hôtel-Dieu de Lévis, Lévis, Québec, Canada.
Sébastien
S
Maire
Service de cardiologie, Département de médecine, Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Québec, Canada.
Richard
R
Harvey
Lady Davis Institute, Montreal, Québec, Canada.
Abbas
A
Kezouh
Division of Cardiology, Department of Medicine, St Paul's Hospital, Vancouver, British Columbia, Canada.
James
J
Nasmith
Unité d'évaluation cardiovasculaire, Institut national d'excellence en santé et en services sociaux (INESSS), Montreal, Québec, Canada; Service de cardiologie, Département multidisciplinaire de cardiologie, Institut universitaire de cardiologie et de pneumologie de Québec, Québec City, Québec, Canada.
Peter
P
Bogaty
D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D010360:Patient Transfer / Q000706:statistics & numerical data; D062645:Percutaneous Coronary Intervention / Q000706:statistics & numerical data; D011792:Quebec / Q000453:epidemiology; D000072657:ST Elevation Myocardial Infarction / Q000401:mortality* / Q000628:therapy*
D005343:Fibrinolytic Agents