In-hospital prognosis and long-term mortality of STEMI in a reperfusion network. "Head to head" analisys : invasive reperfusion vs optimal medical therapy
Garcia Garcia, Cosme (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Ribas Barquet, Núria (Hospital del Mar (Barcelona, Catalunya))
Recasens, Lluís (Hospital del Mar (Barcelona, Catalunya))
Meroño, Oona (Hospital del Mar (Barcelona, Catalunya))
Subirana, Isaac (Institut Hospital del Mar d'Investigacions Mèdiques)
Fernández, A. (Hospital del Mar (Barcelona, Catalunya))
Pérez Pérez, Antonio (Hospital del Mar (Barcelona, Catalunya))
Miranda, F. (Hospital del Mar (Barcelona, Catalunya))
Tizón-Marcos, Helena (Institut Hospital del Mar d'Investigacions Mèdiques)
Martí-Almor, Julio (Institut Hospital del Mar d'Investigacions Mèdiques)
Bruguera Cortada, Jordi (Hospital del Mar (Barcelona, Catalunya))
Elosua, Roberto (Universitat Autònoma de Barcelona. Departament de Medicina)

Fecha:	2017
Resumen:	ST Segment Elevation Acute myocardial infarction (STEMI) preferred treatment is culprit artery reperfusion with primary percutaneous coronary intervention (PPCI). We ought to analyze the benefit of early reperfusion vs. optimal medical therapy in STEMI before and after the set-up of a regional STEMI network that prioritizes PPCI. Between January 2002 and December 2013, 1268 STEMI patients were consecutively admitted in a University Hospital. Patients were classified in two groups: pre-STEMI Network (January 2002-June 2009; n = 670) and post-STEMI network (July 2009-December 2013; n = 598). Vital status was available at 2-year follow-up. The STEMI network increased reperfusion (89. 2% vs 64. 4%, p < 0. 001) mainly using PCI (99. 0% vs 43. 9%, p < 0. 001). In univariate analysis, in-hospital mortality was significantly lower in the post-STEMI network period (2. 51% vs. 7. 16%, p < 0. 001). After multivariate adjustment, including age, sex, comorbidities, severity and reperfusion therapy, a trend to a lower in-hospital mortality was observed (post-Network OR: 0. 50, 95% CI:0. 16-1. 59, p = 0. 24); this trend disappeared when optimal medical therapy was included in the model (post-Network OR: 1. 14, 95% CI:0. 32-4. 08, p = 0. 840). No differences in 2-year mortality were observed (post-Network HR: 0. 83; CI 95%: 0. 55-1. 25, p = 0. 37). A STEMI network with PPCI 24/7 improved reperfusion therapy, resulting in an increase on PPCI. Despite in-hospital mortality decreased with a STEMI network, 2-year mortality remained similar in both periods, pre- and post-Network. Optimal medical therapy could be as important as reperfusion therapy in a STEMI reperfusion network.
Derechos:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Lengua:	Anglès
Documento:	Article ; altres ; Versió publicada
Materia:	Reperfusion network ; AMI prognosis ; Long-term mortality ; Optimal medical therapy ; Reperfusion therapy
Publicado en:	BMC Cardiovascular disorders, Vol. 17 (may 2017) , ISSN 1471-2261

DOI: 10.1186/s12872-017-0574-6
PMID: 28549452

8 p, 623.6 KB

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Documentos de investigación > Documentos de los grupos de investigación de la UAB > Centros y grupos de investigación (producción científica) > Ciencias de la salud y biociencias > Institut d'Investigació en Ciencies de la Salut Germans Trias i Pujol (IGTP)
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