Aims
The aim of this study was to determine the contemporary use of reperfusion therapy in the European Society of Cardiology (ESC) member and affiliated countries and adherence to ESC clinical practice guidelines in patients with ST-elevation myocardial infarction (STEMI).
Methods and results
Prospective cohort (EURObservational Research Programme STEMI Registry) of hospitalized STEMI patients with symptom onset <24 h in 196 centres across 29 countries. A total of 11 462 patients were enrolled, for whom primary percutaneous coronary intervention (PCI) (total cohort frequency: 72.2%, country frequency range 0–100%), fibrinolysis (18.8%; 0–100%), and no reperfusion therapy (9.0%; 0–75%) were performed. Corresponding in-hospital mortality rates from any cause were 3.1%, 4.4%, and 14.1% and overall mortality was 4.4% (country range 2.5–5.9%). Achievement of quality indicators for reperfusion was reported for 92.7% (region range 84.8–97.5%) for the performance of reperfusion therapy of all patients with STEMI <12 h and 54.4% (region range 37.1–70.1%) for timely reperfusion.
Conclusions
The use of reperfusion therapy for STEMI in the ESC member and affiliated countries was high. Primary PCI was the most frequently used treatment and associated total in-hospital mortality was below 5%. However, there was geographic variation in the use of primary PCI, which was associated with differences in in-hospital mortality.
Objective-To evaluate the time course of the recovery of atrial mechanical function after pharmacological cardioversion of chronic atrial fibrillation to sinus rhythm. Patients and methods-21 patients (12 male, 9 female, aged 37-77 years) with chronic atrial fibrillation (< 6 months) were followed up by serial transmitral pulsed Doppler echocardiography. Echocardiographic studies were performed within the first 24 hours and on day 8, 15, and 30 after cardioversion. Results-There was a significant increase (mean (SD)) in the peak A-wave velocity (from 0 35 (0.10) on day 1 to 0 50 (1.73) on day 8, and thereafter a gradual increase to 0*61 (0.14) m/s on day 30). Similarly, integrated late atrial velocities increased from 4 50 (1.46) on day 1 to 5*61 (1.73) on day 8 and 5*97 (1.47) cm/s2 on day 30. The atrial contribution to total transmitral flow increased significantly from 26 (7)% immediately after conversion of atrial fibrillation to sinus rhythm to 34 (7)% on day 30, indicating the haemodynamic benefit of the restoration of sinus rhythm. Left atrial diameter decreased but not significantly, from 4-11 (0.37) to 3-98 (0.34) cm (P < 0.005). In more than 75% of elderly AF patients, the aetiology includes arterial hypertension and sick sinus syndrome, whereas mitral valve disease, thyrotoxicosis, alcohol, anaemia, pericarditis, and cardiosurgical procedures are important aetiological factors in younger patients.4 Elimination of these factors is a precondition for achieving sinus rhythm, and vital for maintaining it. However, in 3% to 31% of cases, AF occurs as an isolated event ("lone atrial fibrillation") without a recognisable cause or structural heart disease.5-7In each patient with AF the aim of treatment is to restore sinus rhythm.
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