Trends in reperfusion therapy of ST segment elevation myocardial infarction in Switzerland: six year results from a nationwide registry

Abstract

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]

Determinants of Costs and the Length of Stay in Acute Coronary Syndromes: A Real Life Analysis of More Than 10 000 Patients

“…By including statistics from the majority of hospitals in Switzerland, the AMIS registry reflects a realistic pattern of the present cost calculation in the management of ACS in the country. Findings about reperfusion therapy of myocardial infarction and the association of dyslipidemia and concomitant risk factors with in hospital mortality in ACS have been derived from data on this registry [12,19]. This ongoing multicenter project, which offers a data input and analysis over the internet, is a useful tool to examine actual trends in cardiology and asses their impact on costs.…”

Admission glycaemia and outcome in patients with acute coronary syndrome

“…The registry was approved by the Over-regional Ethical Committee for Clinical Studies and the Swiss Board of Data Security. 20,21 In March 2005 the AMIS Plus Questionnaire was revised and admission glycaemia was included.…”

Comparison of Primary Percutaneous Coronary Intervention and Fibrinolytic Therapy in ST-Segment-Elevation Myocardial Infarction

“…Patients who received fibrinolytic therapy were older than patients who received primary PCI in 3 observational studies. 34,35,40 There were more patients with anterior STEMI, heart failure, or cardiogenic shock in the primary PCI group in 6 studies 34,39 -41,45,48 and in patients who received fibrinolytic therapy in 2 studies. 33,35 Primary PCI patients received more optimal medical therapy and coronary intervention and were more likely to be treated at high-volume hospitals than patients who received fibrinolytic therapy.…”