Abstract 2406: Comparison Of Invasive Procedures And Medical Treatment In Patients With ST-segment Elevation Myocardial Infarction: Impact Of Initial Admission To Hospitals With Versus Without Catheterization Laboratory. Results From The German ACOS Registry.

Abstract

Introduction: The aim of this analysis was to evaluate the rate of invasive and revascularization procedures and adherence to guideline recommended therapies in patients with STEMI initially admitted to hospitals with and without catheterization laboratory in clinical practice. Methods: Between 07/2000 and 12/2002 16817 patients with an acute coronary syndrome from 154 hospitals have been included in the ACOS registry. 8303 of these patients presented with ST-segment elevation myocardial infarction. 6351 patients (76,5%) were initially admitted to a hospital with catheterization laboratory, 1952 (23,5%) in a hospital without catheterization laboratory. Results: We observed significant differences for treatment during the first 48h and revascularization procedures (table ). In the univariate analysis the total in-hospital and 1-year mortality was significantly lower in patients with initial admission to hospitals with catheterization laboratory (8.8% vs. 11.5%, p<0.001 and 13.7% vs. 19.9%, p<0.0001). However, this was statistically significant after adjustment for age, gender, history of myocardial infarction, diabetes, renal insufficiency, heart rate < 100/min and systolic blood pressure > 100 mmHg for 1-year-mortality only (Odds ratio 0.75; 95% CI 0.65 – 0.88) and not for in-hospital mortality (Odds ratio 0.91; 95% CI 0.76 – 1.10). Conclusions: In clinical practice patients with STEMI admitted to hospitals with catheterization laboratory are treated with significantly higher rates of reperfusion and guideline recommended adjunctive therapies. This is associated with a lower 1-year mortality.