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.
Background
Left atrial appendix, as an essential source of systemic embolism and stroke in patients with atrial fibrillation, can be excluded during cardiac surgery, however the clinical benefit is as yet uncertain.
Methods
A total of 376 out of 3741 consecutive patients with atrial fibrillation presenting a high risk for stroke (CHA2DS2-VASc-Score ≥2 for men and ≥3 for women) who underwent heart surgery with cardiopulmonary bypass between 01/2012 and 12/2015 were analysed for mortality and stroke rate at 30 days, 12 and 24 months. Patients with concomitant LAA-closure alone (group1; n=107) were compared to patients with concomitant surgical ablation and LAA-closure (group2; n=85), and patients without surgical ablation and no LAA-closure (group3; n=184) as controls. To further adjust for pre- and intraoperative risk factors, a propensity score stratification analysis based on patients age, gender, EuroSCORE-2, CHA2DS2-VASc-Score and type of procedure was performed.
Results
Patients age was 72±8 years (mean±SD) and 33% were female. EuroSCORE-2 was 8.7±7.7%, 5.7±3.9%, and 5.4±8.4% and CHA2DS2-VASc-Score was 4.2±1.5, 3.9±1.4, and 4.1±1.4 on average for the respective groups. Mortality did not differ between groups at 30 days, 12 and 24 months. The incidence of stroke was 1.9% at 30 days, 4.8% at 12 and 6.7% at 24 months in group1. There was no stroke at 30 days and 12 months and 1.3% at 24 months in group2, and 1.8% at 30 days, 3.0% at 12 and 24 months in control group3. The overall mortality at 24 months was 27.1%, 20% and 24.6% respectively. After propensity score stratification, stroke rate showed significant benefit in group 2 (P=0.05) at 12 months and a hazard ratio of 0.17, 95% confidents limits 0.02–1.50, (P=0.08) at 24 months, whereas overall mortality did not significantly differ between the groups at 12 and 24 months follow-up.
Conclusions
In this propensity score stratification analysis, patients undergoing cardiac surgery with surgical ablation and concomitant LAA-closure had significant fewer strokes at 12 months follow-up compared to patients undergoing cardiac surgery with LAA-closure alone. Overall mortality did not significantly differ between the groups. Therefore, a concomitant LAA closure during heart surgery without additional surgical ablation does not show any clinical benefit in terms of reduced stroke rate or survival until 12 and 24 months follow-up.
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