Spectrum of reperfusion strategies and factors influencing the use of primary angioplasty in patients with acute myocardial infarction admitted to hospitals with the facilities to perform primary angioplasty

Abstract

Objective-To determine the frequency of the use of primary angioplasty in patients with acute myocardial infarction and the factors influencing its indications in hospitals with the facilities to perform this treatment. Design-Data from the maximal individual therapy in acute myocardial infarction (MITRA) trial were analysed, concerning the eVects of the decisions of individual hospitals, the time of admission of patients, and the eVects of patient characteristics on the selection of reperfusion treatment. Patients-Between June 1994 and January 1997 eight hospitals treated 1532 patients with acute myocardial infarction. 418 (27.3%) were treated conservatively, 641 (41.8%) were treated using intravenous thrombolysis, 387 (25.3%) were treated using primary angioplasty, and 86 (5.6%) received a combination of thrombolysis and angioplasty. Results-The proportion of patients treated with primary angioplasty varied from 1.8% to 57.7% among the eight hospitals. The use of primary angioplasty during non-oYce hours also showed wide variation, ranging from 20% to 54% between centres. The use of thrombolysis was comparatively evenly distributed during the non-oYce hours, ranging from 50-69%. Four hospitals with a primary angioplasty use rate > 30% showed no diVerence in the proportion of patients with contraindications for thrombolysis, high risk patients, or a combination of both, when compared with four hospitals with a lower rate of primary angioplasty use (98/322 (30.4%) v 19/65 (29.2%), respectively, p = 0.847). Conclusions-In hospitals with the facilities for performing primary angioplasty the most important factors influencing its use were the discretion of the individual hospital and the time of patient admission. Characteristics of patients did not influence the choice of reperfusion treatment (Heart 1999;82:420-425)

Logic and logistics: conundrum in reperfusion treatment for acute myocardial infarction

“…Thus, when available promptly, angioplasty is often the optimal strategy of reperfusion. The preferential utilisation of angioplasty during on-hours in the MITRA study1 conforms to this logic . Conversely, the wider use of lytics during off-hours reflects the logistics of primary angioplasty, including difficulty in providing around the clock cover without exaggerated delays, and covering the costs of human and material resources.…”

Transfer of Patients with Acute Myocardial Infarction for Primary or Acute Angioplasty from Hospitals without the Facilities to Perform Angioplasty Results from the Pooled Data of the Maximal Individual Therapy in Acute Myocardial Infarction (MITRA) Registry and the Myocardial Infarction Registry (MIR)

“…This indicates that the policy of the individual hospital is the most important selection factor for transportation. In another analysis of the MITRA data looking at hospitals with angioplasty facilities [20] we also found, that the use of primary angioplasty at such hospitals was mainly dependent on the policy of the individual hospital and the time of symptom onset, but not on patients characteristics.…”

Reperfusion therapy for acute ST-elevation and non ST-elevation myocardial infarction: What can be achieved in daily clinical practice in unselected patients at an interventional center?

“…Such an adherence to guidelines is an important prognostic factor (27). A major factor not to perform a reperfusion therapy in registries was not to use primary PCI as the first line reperfusion therapy (32), which is of special importance at hospitals without catheterization facilities. At such hospitals only a small proportion of patients will be transferred for primary PCI (33).…”