Objective: To document the trends in reperfusion therapy for ST segment elevation myocardial infarction (STEMI) in Switzerland. Design: National prospective multicentre registry, AMIS Plus (acute myocardial infarction and unstable angina in Switzerland), of patients admitted with acute coronary syndromes. Setting: 54 hospitals of varying size and capability in Switzerland. Patients: 7098 of 11 845 AMIS Plus patients who presented with ST segment elevation or left bundle branch block on the ECG at admission. Main outcome measures: In-hospital mortality and its predictors at admission by multivariate analysis. Results: The proportion of patients treated by primary percutaneous coronary intervention (PCI) progressively increased from 1997 to 2002, while the proportion with thrombolysis or no reperfusion decreased (from 8.0% to 43.1%, from 47.2% to 25.6%, and from 44.8% to 31.4%, respectively). Overall in-hospital mortality decreased over the study period from 12.2% to 6.7% (p , 0.001). Main in-hospital mortality predictors by multivariate analysis were primary PCI (odds ratio (OR) 0.52, 95% confidence interval (CI) 0.33 to 0.81), thrombolysis (OR 0.63, 95% CI 0.47 to 0.83), and Killip class III (OR 3.61, 95% CI 2.49 to 5.24) and class IV (OR 5.97, 95% CI 3.51 to 10.17) at admission. When adjusted for the year, multivariate analysis did not show PCI to be significantly superior to thrombolysis for in-hospital mortality (OR 1.2 for PCI better, 95% CI 0.8 to 1.9, p = 0.42). Conclusion: Primary PCI has become the preferred mode of reperfusion for STEMI since 2002 in Switzerland, whereas use of intravenous thrombolysis has decreased from 1997 to 2002. Furthermore, there was a major reduction of in-hospital mortality over the same period.
Since it was found in the mid 1970s that acute myocardial infarction resulted from a ruptured atherosclerotic plaque, causing thrombosis and occlusion of a coronary artery, 1 and that restoration of flow salvages myocardium, major attention has been focused on reperfusion therapy. Several studies have documented the survival benefit provided by a thrombolytic, first by intracoronary administration and later intravenously.2-5 Numerous randomised controlled trials soon followed comparing intravenous thrombolysis with mechanical reperfusion by primary percutaneous coronary intervention (PCI). A meta-analysis of 23 randomised controlled trials comparing these two modes of reperfusion in ST segment elevation myocardial infarction (STEMI) showed a greater benefit associated with primary PCI in terms of short and long term mortality, non-fatal reinfarction, and stroke. 6 On the basis of this information, national and international societies of cardiology have established guidelines concerning the management of STEMI.7 8 To assess how these translate into the ''real world'' of daily clinical practice, several short and long term registry based studies have been conducted. [9][10][11][12][13][14][15]