Comparative analysis between 2 periods of acute myocardial infarction after a decade in Mallorca. IBERIA Study (1996–1998) and Infarction-Code (2008–2010)

Abstract

ObjectiveTo investigate the differences in mortality at 28 days and other prognostic variables in 2 periods: IBERICA-Mallorca (1996–1998) and Infarction Code of the Balearic Islands (IC-IB) (2008–2010). DesignTwo observational prospective cohorts. SettingHospital Universitario Son Dureta, 1996–1998 and 2008–2010. PatientsAcute coronary syndrome with ST elevation of ≤24h of anterior and inferior site. Main variables of interestAge, sex, cardiovascular risk factors, site of AMI, time delays, reperfusion therapy with fibrinolysis and primary angioplasty, administration of acetylsalicylic acid, beta blockers and angiotensin converting enzyme inhibitors. Killip class, malignant arrhythmias, mechanical complications and death at 28 days were included. ResultsFour hundred and forty-two of the 889 patients included in the IBERICA-Mallorca and 498 of 847 in the IC-IB were analyzed. The site and Killip class on admission were similar in both cohorts. The main significant difference between IBERICA and IC-IB group were age (64 vs. 58 years), prior myocardial infarction (17.9 vs. 8.1%), the median symptoms to first ECG time (120 vs. 90min), median first ECG to fibrinolysis time (60 vs. 35min), fibrinolytic therapy (54.8 vs. 18.7%), patients without revascularization treatment (45.9 vs. 9.2%), primary angioplasty (1.0% vs. 92.0%). The mortality at 28 days was lower in the IC-IB (12.2 vs. 7.2%; hazard ratio 0.560; 95% CI 0.360–0.872; P=.010). ConclusionThe 28-day mortality in acute coronary syndrome with ST elevation in Mallorca has declined in the last decade, basically due to increased reperfusion therapy with primary angioplasty and reducing delays time to reperfusion.