Primary Percutaneous Intervention of ST-elevation Myocardial Infarction in Austria: Results From the Austrian Acute PCI Registry 2005-2007

Wien Klin Wochenschr. 2010 Apr;122(7-8):220-8. doi: 10.1007/s00508-010-1352-y.

Abstract

Background: Primary percutaneous coronary intervention (PPCI) has become the preferred reperfusion strategy in ST-elevation myocardial infarction (STEMI). Implementation of networks of care and registries providing continuous quality assessment are key components for optimal management in patients with STEMI.

Aim: To analyze procedural success and in-hospital outcome of interventional therapy of STEMI in Austria.

Methods: We evaluated a total number of 4016 consecutive STEMI patients registered in the first three years after implementation of the Austrian acute PCI registry in January 2005.

Results: The rate of PPCI as an indication for acute coronary intervention increased from 83.5% in 2005 to 92.4% in 2007 (P < 0.0001). During this period the median door-to-balloon time decreased from 60.0 (40.0-90.0) min to 53.0 (30.0-80.0) min (P = 0.012). The percentage of patients receiving adequate adjunctive antithrombotic therapy with ASA/heparin and clopidogrel significantly increased (78.8-85.1% and 67.8-90.3%, respectively; P < 0.001). Overall in-hospital mortality was 9.6% in rescue PCI, 6.4% in facilitated PCI and 5.1% in PPCI. On multivariate analysis, cardiogenic shock (OR: 20.21, 95% CI: 12.21-33.44, P < 0.001), resuscitation (OR: 2.62, 95% CI: 1.47-4.69, P = 0.01), age (OR: 1.04, 95% CI: 1.02-1.06, P < 0.001) and angiographic success (OR: 5.93, 95% CI: 3.33-10.57, P < 0.001) were independent predictors of in-hospital death.

Conclusion: Continuous nationwide efforts to establish regional networks for STEMI treatment in the years 2005-2007 led to a decrease in door-to-balloon time, improved adjunctive antithrombotic therapy and an in-hospital mortality of 5%. Results of interventional STEMI treatment in Austria are in accordance with current guidelines and with other contemporary registries.

MeSH terms

  • Aged
  • Angioplasty, Balloon, Coronary*
  • Austria
  • Combined Modality Therapy
  • Community Networks
  • Coronary Angiography
  • Electrocardiography
  • Female
  • Fibrinolytic Agents / therapeutic use
  • Hospital Mortality
  • Humans
  • Male
  • Middle Aged
  • Myocardial Infarction / diagnosis
  • Myocardial Infarction / mortality
  • Myocardial Infarction / therapy*
  • Outcome and Process Assessment, Health Care* / statistics & numerical data
  • Prognosis
  • Quality Assurance, Health Care / statistics & numerical data
  • Registries*
  • Time and Motion Studies

Substances

  • Fibrinolytic Agents