Use Of Reperfusion Therapy Research Articles

Analysis of situation of acute coronary syndrome based on the date of the Improving Care for Cardiovascular Disease in China–Acute Coronary Syndrome (CCC-ACS) project: single-centre observational study

BackgroundWe are currently faced with an increasing burden of cardiovascular disease in China and the inadequacy of the application of guidelines in clinical practice. In the past decade, China has...

Effects of a Consensus-Based Pulmonary Embolism Treatment Algorithm and Response Team on Treatment Modality Choices, Outcomes, and Complications.

Pulmonary embolism (PE) treatment depends on disease severity and risk of complications. Physician and institutional expertise may influence the use of reperfusion therapy (RT) such as systemic thrombolysis (SL) and catheter-directed interventions (CDI). We aimed to investigate the effects of a consensus-based treatment algorithm (TA) and subsequent implementation of PE response team (PERT) on RT modality choices and patient outcomes. A cohort of PE patients admitted to a tertiary care hospital between 2012 and 2017 was retrospectively evaluated. Demographics, clinical variables, RT selections, and patient outcomes during 3 consecutive 2-year periods (baseline, with TA, and with TA+PERT) were compared. Descriptive statistics were used for data analysis. A total of 1105 PE patients were admitted, and 112 received RT. Use of RT increased from 4.7% at baseline to 8.2% and 16.1% during the TA and TA+PERT periods. The primary RT modality transitioned from CDI to SL, and reduced-dose SL became most common. Treatment selection patterns remained unchanged after PERT introduction. Hospital length of stay decreased from 4.78 to 2.96 and 2.81 days (P < .001). Most of the hemorrhagic complications were minor, and their rates were similar across all 3 periods and between SL and CDI. No major hemorrhages occurred in patients treated with reduced-dose SL. In conclusion, TA and PERT represent components of a decision support system facilitating treatment modality selection, contributing to improved outcomes, and limiting complications. Treatment algorithm emerged as a factor providing consistency to PERT recommendations.

Epidemiological trends of acute coronary syndrome in Shimla district of the hilly state of Northern India: Six-year data from the prospective Himachal Pradesh acute coronary syndrome registry

ObjectivesThe epidemiological trends of incidence, treatment practices, and outcomes are reported from Shimla district of the northern state of India. MethodsThe data of clinical characteristics, treatment practices, and outcomes of patients with acute coronary syndrome (ACS) diagnosed using standard criteria were collected systematically from the defined hilly geographical region of the northern state of India from January 2013 to December 2018 as the part of Himachal Pradesh acute coronary syndrome (HP ACS) registry. The year-wise trends of incidence, demographic, clinical characteristics, treatment practices, and in-hospital mortality are reported. ResultsThe incidence of ACS shows declining trends. The mean age at incident ACS is increasing without change in gender predilection. The prevalence of overweight/obesity and diabetes has increased significantly since 2013 but tobacco consumption has not changed. The reperfusion therapy has increased significantly (20.9% in 2013 to 42.1% in 2018, p < 0.01) primarily because of an increased use of percutaneous coronary angioplasty. There is a trend of increasing use of beta blockers. The use of other oral secondary preventive drugs remained more than 90% since 2013. The in-hospital mortality rate is declining (9.0% in 2013 to 6.0% in 2018, p < 0.01). ConclusionsEpidemiological characteristics of the ACS population in Shimla district are changing. The trends of use of reperfusion therapy in ST segment elevated myocardial infarction population has although increased but is still suboptimal, and there is a need for taking initiatives both at the system and population level to improve the reperfusion therapy.

Sex-Related Differences in In-Hospital Mortality in Japanese ST-Elevation Acute Myocardial Infarction Patients Presenting to Hospital in the 24 Hours After Symptom Onset - Results From K-ACTIVE.

Background: Despite the drastic advances in clinical care for patients with acute ST-elevation myocardial infarction (STEMI), female STEMI patients have higher in-hospital mortality rates than male patients. This study assessed the influence of sex on in-hospital mortality in STEMI patients in Kanagawa Prefecture, Japan.Methods and Results: From October 2015 to June 2018, 2,491 consecutive STEMI patients (23.9% female) who presented to hospital in the 24 h after symptom onset were analyzed. The female patients were 9 years older and less frequently had diabetes, smoking and prior MI than male patients. Pre-hospital managements, including prehospital 12-lead electrocardiography, and symptom-to-door time were similar between the sexes. A door-to-device time ≤90 min was achieved in 61.3% of female cases and in 65.0% of male cases (P=0.13). Reperfusion therapy was provided to 94.6% of female and 97.6% of male patients (P<0.001). In-hospital mortality rate was not significantly different between female and male patients (6.6% vs. 7.8%, P=0.37). On multivariate logistic regression analysis, female sex itself was not associated with in-hospital mortality (OR, 1.52; 95% CI: 0.67–3.47, P=0.32).Conclusions: There was no sex discrepancy in the in-hospital mortality of STEMI patients in this study. Guideline-based treatment, such as advanced pre-hospital management and a high use of reperfusion therapy might have attenuated the sex-related differences in the in-hospital mortality.

The ESC ACCA EAPCI EORP acute coronary syndrome ST-elevation myocardial infarction registry.

The Acute Cardiac Care Association (ACCA)-European Association of Percutaneous Coronary Intervention (EAPCI) Registry on ST-elevation myocardial infarction (STEMI) of the EurObservational programme (EORP) of the European Society of Cardiology (ESC) registry aimed to determine the current state of the use of reperfusion therapy in ESC member and ESC affiliated countries and the adherence to ESC STEMI guidelines in patients with STEMI. Between 1 January 2015 and 31 March 2018, a total of 11462 patients admitted with an initial diagnosis of STEMI according to the 2012 ESC STEMI guidelines were enrolled. Individual patient data were collected across 196 centres and 29 countries. Among the centres, there were 136 percutaneous coronary intervention centres and 91 with cardiac surgery on-site. The majority of centres (129/196) were part of a STEMI network. The main objective of this study was to describe the demographic, clinical, and angiographic characteristics of patients with STEMI. Other objectives include to assess management patterns and in particular the current use of reperfusion therapies and to evaluate how recommendations of most recent STEMI European guidelines regarding reperfusion therapies and adjunctive pharmacological and non-pharmacological treatments are adopted in clinical practice and how their application can impact on patients' outcomes. Patients will be followed for 1 year after admission. The ESC ACCA-EAPCI EORP ACS STEMI registry is an international registry of care and outcomes of patients hospitalized with STEMI. It will provide insights into the contemporary patient profile, management patterns, and 1-year outcome of patients with STEMI.

Twenty-year trends in profile, management and outcomes of patients with ST-segment elevation myocardial infarction according to use of reperfusion therapy: Data from the FAST-MI program 1995-2015

We used data from 5 one-month French nationwide registries, conducted 5 years apart from 2005 to 2015, including 8579 STEMI patients (67% with and 33% without reperfusion therapy) admitted to cardiac intensive care units in France. Use of reperfusion therapy increased from 49% in 1995 to 82% in 2015, with a shift from fibrinolysis (37.5% to 6%) to pPCI (12% to 76%). Early use of evidence-based medications gradually increased over the period in both patients with and without reperfusion therapy, although it remained lower at all times in those without reperfusion therapy. One-year mortality decreased in patients with reperfusion therapy (from 11.9% in 1995 to 5.9% in 2010 and 2015, hazard ratio [HR] adjusted on baseline profile 0.40; 95% CI: 0.29-0.54, P < .001) and in those without reperfusion therapy (from 25.0% to 18.2% in 2010 and 8.1% in 2015, HR: 0.33; 95% CI: 0.24-0.47, P < .001). In STEMI patients, one-year mortality continues to decline, both related to increased use of reperfusion therapy and progress in overall patient management. In patients with reperfusion therapy, mortality has remained stable since 2010, while it has continued to decline in patients without reperfusion therapy.

Improving Care of STEMI in the United States 2008 to 2012.

BackgroundWe aimed to determine the change in treatment strategies and times to treatment over the first 5 years of the Mission: Lifeline program.Methods and ResultsWe assessed pre‐ and in‐hospital care and outcomes from 2008 to 2012 for patients with ST‐segment–elevation myocardial infarction at US hospitals, using data from the National Cardiovascular Data Registry Acute Coronary Treatment and Intervention Outcomes Network Registry—Get With The Guidelines Registry. In‐hospital adjusted mortality was calculated including and excluding cardiac arrest as a reason for primary percutaneous coronary intervention delay. A total of 147 466 patients from 485 hospitals were analyzed. There was a decrease in the proportion of eligible patients not treated with reperfusion (6.2% versus 3.3%) and treated with fibrinolytic therapy (13.4% versus 7.0%). Median time from symptom onset to first medical contact was unchanged (≈50 minutes). Use of prehospital ECGs increased (45% versus 71%). All major reperfusion times improved: median first medical contact‐to‐device for emergency medical systems transport to percutaneous coronary intervention–capable hospitals (93 to 84 minutes), first door‐to‐device for transfers for primary percutaneous coronary intervention (130 to 112 minutes), and door‐in–door‐out at non–percutaneous coronary intervention–capable hospitals (76 to 62 minutes) (all P<0.001 over 5 years). Rates of cardiogenic shock and cardiac arrest, and overall in‐hospital mortality increased (5.7% to 6.3%). Adjusted mortality excluding patients with known cardiac arrest decreased by 14% at 3 years and 25% at 5 years (P<0.001).ConclusionsQuality of care for patients with ST‐segment–elevation myocardial infarction improved over time in Mission: Lifeline, including increased use of reperfusion therapy and faster times‐to‐treatment. In‐hospital mortality improved for patients without cardiac arrest but did not appear to improve overall as the number of these high‐risk patients increased.

In-Hospital ST-Segment Elevation Myocardial Infarction

ImportanceIn-hospital ST-segment elevation myocardial infarction (STEMI) is a unique clinical entity with epidemiology, incidence, and outcomes distinct from that of out-of-hospital STEMI and has only within the past 10 years begun to receive increased attention and research. Patients with in-hospital STEMI are older, have more comorbidities, and more frequently have coagulopathies and contraindications for anticoagulation and fibrinolytic therapy. A standardized clinical definition of in-hospital STEMI is lacking. The objectives of this special communication are to (1) summarize the knowledge base regarding in-hospital STEMI; (2) review the challenges of diagnosis and treatment of patients with in-hospital STEMI; (3) present a standardized clinical definition for in-hospital STEMI; and (4) provide a quality improvement protocol to improve diagnosis, triage, and treatment of patients with in-hospital STEMI.ObservationsPatients with in-hospital STEMI less frequently present with typical angina symptoms, and an electrocardiogram is often obtained owing to changes in clinical status, changes on telemetry, or a finding of elevated cardiac biomarker. The frequent nontypical presentations often lead to substantial delays in the diagnosis of STEMI. Only 34% to 71% of patients with in-hospital STEMI undergo diagnostic catheterization, and only 22% to 56% undergo percutaneous coronary intervention. Even in contemporary reports, some studies report in-hospital mortality in the range of 31% to 42%. Three areas of delay in the treatment of patients with in-hospital STEMI that merit particular attention are (1) delays in electrocardiogram acquisition, (2) delays in electrocardiogram interpretation, and (3) delays in activation of existing STEMI systems of care.Conclusions and RelevanceTreatment of patients with in-hospital STEMI is more complex and challenging than treatment of patients who develop out-of-hospital STEMI, leading to delays in diagnosis and triage and less frequent use of reperfusion therapy. Quality improvement programs targeted at decreasing delays and streamlining treatment of such patients may improve treatment and outcome.

Abstract WP195: Current Status of Reperfusion Therapy and Functional Outcome in Acute Ischemic Stroke Patients With Non-Valvular Atrial Fibrillation: a Single-Center, Six-Year Experience of Consecutive 546 Patients

Background: The concept and tools of oral anticoagulation (OAC) therapy for preventing stroke in patients with non-valvular atrial fibrillation (NVAF) and their use as part of an acute treatment regimen in patients experiencing large-vessel occlusive stroke have grossly changed in the last 10 years. The aim of this study was therefore to evaluate the changes in reperfusion therapy and the clinical outcomes in acute ischemic stroke (AIS) patients with NVAF during a six-year time period. Methods: From March 2011 to March 2017, consecutive patients with AIS with NVAF who were admitted to our department were retrospectively analyzed. Patients were divided into three groups according to the year of their initial visit: 2011-2012 (n=136), 2013-2014 (n=206), and 2015-2016 (n=204). Reperfusion therapy including intravenous thrombolysis and endovascular therapy, and functional outcome, were compared between the three time periods. Results: The rate of reperfusion therapy increased steadily from 19.9% in 2011-2012 to 42.7% in 2015-2016 ( P &lt; 0.0001). Parenchymal hematoma (PH) occurrence increased slightly from 5.9% in 2011-2012 to 9.8% in 2015-2016, but there was no significant difference ( P = 0.4301). Although there was no difference with respect to National Institutes of Health Stroke Scale (NIHSS) score at admission between the 2011-2012 and 2015-2016 groups (8 vs. 7, P = 0.3926), and CHA 2 DS 2 -VASc score was significantly higher in 2015-2016 compared with in 2011-2012 (4 vs 3, P = 0.0062), and discharge NIHSS score in 2015-2016 was significantly lower compared with that in 2011-2012 (2 vs. 4; P = 0.0093). The percentage of modified Rankin Scale 0-1 upon discharge was significantly higher in patients treated with reperfusion therapy than in those who were treated without it, among moderate-severe stroke patients (initial NIHSS ≥ 8) (15.4 vs. 2.8%, P = 0.0002). Moreover, hospital mortality rate significantly decreased from 11.0% in 2011-2012 to 3.4% in 2015-2016 ( P = 0.0167). Conclusions: According to the six-year trend, the use of reperfusion therapy increased steadily and this increase appears to be factor in improvement of functional outcome and mortality in patients with AIS with NVAF.

Long-term outcome and risk assessment in premature acute myocardial infarction: A 10-year follow-up study

BackgroundPremature acute myocardial infarction (AMI) is a rare disease carrying significant morbidity and mortality. Existing data on outcome in these patients is based on retrospective analysis of angiographic reports or refer to time periods with incomparable treatment regimes, making them unusable for risk assessment in times of widespread use of reperfusion therapy. Aim of this study was to assess the outcome of premature AMI in a prospectively recruited study population enrolled in the times of modern reperfusion therapy. MethodsWe included 102 consecutive AMI survivors (≤40years) in this prospective multicentre study. Outcome was assessed via retrieval query of the Austrian Death Registry and the centralized patient management system of Vienna. ResultsDuring a median follow up time of 10.3years (IQR:8.9–11.1), 23% of all patients experienced MACE, of those 6% died, 17% experienced re-AMI and 5% patients an ischemic stroke. Furthermore, forty patients underwent cardiac re-catheterization and twenty-five needed recurrent revascularization. MACE were associated among the classic cardiovascular risk factors with elevated levels of HbA1c (adj. HR 1.32; 95%CI 1.06–1.64; P=0.012), total cholesterol (adj. HR 2.16; 95%CI 1.27–3.48; P=0.004), and c-reactive protein (adj. HR 1.67; 95%CI 1.29–2.17; P=0–003) for an increase of 1-standard deviation. ConclusionAlthough myocardial re-infarction was the driving force of morbidity in premature myocardial infarction, we observed an excellent long-term survival opposed to previous reports. We found that persistence risk factors rather than the clinical risk profile at baseline influences the outcome in these patients, emphasizing the importance of secondary prevention in young patients after AMI.

Abstract 17876: Risk Factors and Thirty-day Adverse Events in Emergency Department Patients With Symptoms of Myocardial Ischemia With and Without Diabetes

Objective: To evaluate the association between diabetes and demographic and clinical characteristics and 30-day adverse cardiovascular events (return to the emergency department [ED] with signs and/or symptoms of acute myocardial ischemia, all-cause admission, acute myocardial infarction, use of reperfusion therapy, and all-cause mortality) in patients presenting to the ED with chest pain and/or symptoms suggestive of acute myocardial ischemia. Methods: We conducted a cross-sectional study of 163 adult patients presenting to the ED at a single hospital with symptoms of acute myocardial ischemia warranting evaluation with an electrocardiogram and a cardiac troponin test. We analyzed data collected 30±7 days after ED/hospital discharge from the index visit. Using chi-squared tests, we compared patients with a history of diabetes (n=65) to those without (n=98) on demographic and clinical characteristics and on 30-day adverse cardiovascular events. Findings: Patients with a history of diabetes were significantly more likely to be older (p&lt;.001), overweight (p=.003), have a history of coronary artery disease (p&lt;.001), heart failure (p=.016), and hyperlipidemia (p&lt;.001) than patients without a history of diabetes. We found a significant association between a history of diabetes and a composite of 30-day adverse cardiovascular events (p=.036). We also found a significant association between a history of diabetes and admission to the hospital within 30 days of the index visit (p=.015). Conclusion: Study findings emphasize the predominance of more modifiable and non-modifiable cardiovascular risk factors in patients with diabetes compared to those without diabetes among patients presenting to the ED with signs and/or symptoms of acute myocardial ischemia. Past research has demonstrated a strong association of optimal weight, glycemic, and blood pressure management with protective benefits in patients with diabetes. Tailored educational interventions in the ED may reduce modifiable risks in these patients, their hospital return rate, and likelihood of 30-day adverse cardiovascular outcomes.

Predictors, treatment, and outcomes of STEMI occurring in hospitalized patients.

ST-segment elevation myocardial infarction (STEMI) is most commonly caused by an acute thrombotic occlusion of a coronary artery. For patients in whom the onset of STEMI occurs outside of hospital (outpatient STEMI), early reperfusion therapy with either fibrinolysis or primary percutaneous coronary intervention reduces complications and improves survival, compared with delayed reperfusion. STEMI systems of care are defined as integrated groups of separate entities focused on reperfusion therapy for STEMI, generally including emergency medical services, emergency medicine, cardiology, nursing, and hospital administration. These systems of care have been successful at reducing total ischaemia time and outpatient STEMI mortality. By contrast, much less is known about STEMI that occurs in hospitalized patients (inpatient STEMI), which has unique clinical features and much worse outcomes than outpatient STEMI. Inpatient STEMI is associated with older age, a higher female:male ratio, and more comorbidities than outpatient STEMI. Delays in diagnosis and infrequent use of reperfusion therapy probably also contribute to unfavourable outcomes for inpatient STEMI.

Temporal trends in the use of reperfusion therapy and outcomes in elderly patients with first ST elevation myocardial infarction.

To analyze secular trends in management and short and long-term prognosis of elderly presenting with ST-elevation myocardial infarction (STEMI). All patients ≥ 75 years with first STEMI admitted to our Coronary Care Unit between 1988 and 2008 were included. Baseline characteristics, clinical management, in-hospital and post-discharge outcomes in 4 time periods (1988-1993, 1994-1998, 1999-2003, 2004-2008) were compared. The final cohort consisted of 1393 patients. During the study period, there was a significant increase in the use of aspirin, β-blockers and ACE inhibitors. A significant reduction in the development of cardiogenic shock and mechanical complications was noticed. The use of reperfusion therapy increased significantly, due to a wider use of primary percutaneous coronary intervention (PPCI) while 30-days, 1-year and 5-year mortality decreased throughout the 20-year study period (p<0.001). In the multivariable logistic regression model, patients treated with PPCI showed a significantly lower 30-day (OR 0.47, 95% CI, 0.31-0.71), 1-year (OR 0.62, 95% CI 0.43-0.88) and 5-year mortality (OR 0.57, 95% CI 0.41-0.79) while patients receiving fibrinolysis showed a non-significant improvement in 30-day (OR 0.86, 95% CI 0.62-1.49), 1-year (OR 0.86, 95% CI 0.58-1.30) and 5-year mortality (OR 0.82, 95% CI 0.56-1.19). The use of reperfusion therapy, and particularly of PPCI, for elderly patients suffering from STEMI increased significantly during the study period. This change in therapy was associated with a marked improvement in short and long-term prognosis.

Abstract 17595: The Value of Continuous ST-Segment Monitoring in the Emergency Department: a Quasi-Experimental Pre-Post Study

Purpose: The AHA Practice Standards for ECG Monitoring recommend continuous ST-segment monitoring (C-STM) in patients presenting to the emergency department (ED) with signs and/or symptoms suggestive of acute coronary syndrome (ACS), but few studies have evaluated its use in the ED. Our aims were to compare the time to diagnosis and 30-day adverse events (return to the ED with signs and/or symptoms of ACS, hospital admission, acute myocardial infarction, use of reperfusion therapy, or mortality) before and after implementation of C-STM. We also evaluated the diagnostic accuracy of C-STM in detecting ischemia or infarction, using stress test and troponin I results as reference standards. Methods: We prospectively studied 163 adults (pre-intervention phase: n=78; intervention phase: n=85) in the ED at a single hospital. We stratified patients into low (n=51), intermediate (n=100), or high (n=12) risk using HEART scores. The principal investigator monitored participants, activating C-STM on bedside monitors in the intervention phase. We used likelihood ratios (LRs) as the measure of diagnostic accuracy. By convention, a positive (+) LR is diagnostic at &gt;10 and a negative (-) LR at &lt;0.1. Results: Overall, 9% of patients were diagnosed with ACS. There was no significant difference in median time to ACS diagnosis before and after implementation of C-STM (5.55 vs. 5.98 hours; p=0.43 for Mann-Whitney U test). In risk-stratified analyses, no significant pre-post difference in time to ACS diagnosis was found in low-, intermediate-, or high-risk patients. There was no difference in the rate of any 30-day adverse event before vs. after C-STM implementation (11.5% vs. 10.6%; p=0.85 Chi-squared test). None of 3 episodes of ST-segment changes on C-STM represented ACS. The +LR and -LR of C-STM for ischemia were 24.0 (95% CI 1.4 - 412.0) and 0.3 (95% CI 0.02 - 2.9), respectively; and for infarction were 13.7 (95% CI 1.7 - 112.3) and 0.7 (95% CI 0.3 - 1.5), respectively. Conclusion: In this sample of mainly low- to intermediate-risk patients, use of C-STM did not improve time to diagnosis or 30-day adverse outcomes, nor provide much benefit in detecting myocardial ischemia or infarction. Use of C-STM may need to be re-evaluated for patients with low to intermediate risk for ACS in the ED.

Long Term Trend of Decreased Incidence and Mortality of Right Ventricular Infarction in Association with Increased Use of Reperfusion Therapy

Long Term Trend of Decreased Incidence and Mortality of Right Ventricular Infarction in Association with Increased Use of Reperfusion Therapy

0268: TREM-1 modulation improves cardiac function during myocardial infarction in pigs

The widespread use of reperfusion therapy have led to an important improvement in short-term mortality after acute myocardial infarction (MI), but long-term mortality remains high. The Triggering Receptor Expressed on Myeloid cells-1 (TREM-1) belongs to the immunoreceptors superfamily and acts as an amplifier of the inflammatory response triggered by TLRs engagement during both infectious and aseptic inflammatory diseases. We hypothesized that administration of LR12, a synthetic peptide able to inhibit TREM-1 activation, could be beneficial at the acute phase of MI, in a clinically relevant model of experimental MI in pigs. MI was induced in fifteen anesthetized and mechanically ventilated pigs weighing 45–55 kg, by inflation of an angioplasty balloon in the proximal left anterior descending (LAD) coronary artery cannulated under X-ray guidance, during 60 minutes. Fifteen minutes before deflation, animals were randomized to receive either LR12 (n=7) or LR12-scramble (n=8). Complete hemodynamic and functional parameters were monitored through arterial line, swan-ganz and intraventricular conductance catheters. Resuscitation was conducted by experienced intensivists according to standard protocols used in clinical practice. The monitoring was prolonged until H18, then survivors were euthanized. The decrease in mean arterial pressure (MAP) was significantly limited during the monitoring period from H12 to the end (-22.1% vs -3.9%, p<.01). Cardiac index and cardiac power index, one of the strongest hemodynamic correlate of mortality in cardiogenic shock, were preserved under LR12 regimen (72% vs 45% from baseline value, p<.05) as well as SvO2 value (74% vs 62%, p<.05). Ejection fraction and parameters of systolic function improved under LR12 treatment. TREM-1 inhibition by LR12 at the acute phase of myocardial infarction in invasively monitored pigs limits reperfusion injury and alteration of ventricular contractility.

Increasing Use of Computed Tomographic Perfusion and Computed Tomographic Angiograms in Acute Ischemic Stroke From 2006 to 2010

Our objective was to study nationwide utilization trends of computed tomographic (CT) angiogram (CTA) and CT perfusion (CTP) in acute ischemic stroke and particularly in the context of use of reperfusion therapies. We reviewed the Premier Perspective Database for ischemic stroke-related hospitalizations of adult patients during a 5-year period, 2006 to 2010. Use of multimodal CT-based imaging and reperfusion therapies was determined through the procedure and billing codes. Logistic regression was used to identify predictors of utilization of imaging studies and reperfusion treatments. An increasing proportion of ischemic strokes received CTA each year: 3.8% in 2006, 5.6% in 2007, 6.5% in 2008, 7.5% in 2009, and 9.1% in 2010 (P<0.0001). The proportion of acute strokes that were imaged with CTP imaging also increased each year: 0.05% in 2006, 0.05% in 2007, 0.9% in 2008, 2.2% in 2009, and 2.9% in 2010 (P<0.0001). Reperfusion treatment was more common among those who were imaged with CTA (13.0%) and CTP (17.6%) compared with those with CT head alone (4.0%; P<0.0001). Specifically, higher rates of recombinant tissue-type plasminogen activator were observed in CTA (10.2%) and CTP (11.4%) compared with those with CT head alone (3.8%; P<0.0001). Similarly, higher rates of mechanical embolectomy were observed in CTA (2.8%) and CTP (6.3%) compared with those with CT head alone (0.2%; P<0.0001). There was a marked increase in the rate of CTA and CTP studies in setting of acute ischemic stroke from 2006 to 2010, and both modalities were associated with increased reperfusion therapy use.

Reperfusion therapy for ST elevation acute myocardial infarction 2010/2011: current status in 37 ESC countries

Primary percutaneous coronary intervention (PPCI) is the preferred reperfusion therapy in ST-elevation myocardial infarction (STEMI). We conducted this study to evaluate the contemporary status on the use and type of reperfusion therapy in patients admitted with STEMI in the European Society of Cardiology (ESC) member countries. A cross-sectional descriptive study based on aggregated country-level data on the use of reperfusion therapy in patients admitted with STEMI during 2010 or 2011. Thirty-seven ESC countries were able to provide data from existing national or regional registries. In countries where no such registries exist, data were based on best expert estimates. Data were collected on the use of STEMI reperfusion treatment and mortality, the numbers of cardiologists, and the availability of PPCI facilities in each country. Our survey provides a brief data summary of the degree of variation in reperfusion therapy across Europe. The number of PPCI procedures varied between countries, ranging from 23 to 884 per million inhabitants. Primary percutaneous coronary intervention and thrombolysis were the dominant reperfusion strategy in 33 and 4 countries, respectively. The mean population served by a single PPCI centre with a 24-h service 7 days a week ranged from 31 300 inhabitants per centre to 6 533 000 inhabitants per centre. Twenty-seven of the total 37 countries participated in a former survey from 2007, and major increases in PPCI utilization were observed in 13 of these countries. Large variations in reperfusion treatment are still present across Europe. Countries in Eastern and Southern Europe reported that a substantial number of STEMI patients are not receiving any reperfusion therapy. Implementation of the best reperfusion therapy as recommended in the guidelines should be encouraged.

Protocol for a prospective, controlled study of assertive and timely reperfusion for patients with ST-segment elevation myocardial infarction in Tamil Nadu: the TN-STEMI programme

IntroductionOver the past two decades, India has witnessed a staggering increase in the incidence and mortality of ST-elevation myocardial infarction (STEMI). Indians have higher rates of STEMI and younger populations...

TCT-216 Predictors Of Patient-Oriented And Device-Oriented Outcomes Among Patients Undergoing Primary Percutaneous Coronary Intervention

Background: Treatment of STEMI has considerably evolved over the past 2 decades. However, predictors of adverse events after STEMI are mostly based on early studies without consistent use of reperfusion therapy, P2Y12 inhibitors, and drug-eluting stent implantation. We aimed to identify predictors of adverse events among patients with ST-elevation myocardial infarction (STEMI) undergoing contemporary primary percutaneous coronary intervention (PCI). Methods: Individual data of 2655 patients from 2 primary PCI trials (EXAMINATION, N=1504; COMFORTABLE-AMI, N=1161) with identical endpoint definition and event adjudication were pooled. Predictors of patient-oriented (death or reinfarction) and device-oriented (definite stent thrombosis [ST] and target-lesion revascularization [TLR]) outcomes at 1 year were identified by multivariable Cox regressions analysis. Results: Killip class III/IV was the strongest predictor of death or reinfarction (OR5.11, 95%CI2.48-10.52), ST (OR7.74, 95%CI2.87-20.93), and any TLR (OR2.88, 95%CI1.17-7.06). Impaired LVEF (OR4.77, 95%CI2.10-10.82), final TIMI flow 0-2 (OR1.93, 95%CI1.05-3.54), hypertension (OR1.69, 95%CI1.11-2.59), age (OR1.68, 95%CI1.41-2.01), and peak CK (OR1.25, 95%CI1.02-1.54) were independent predictors of death or reinfarction. Allocation to treatment with DES was an independent predictor of a lower risk of ST (OR0.35, 95%CI0.16-0.74) and any TLR (OR0.34, 95%CI0.21-0.54). Conclusions: Killip class remains the strongest predictor of death or reinfarction among STEMI patients undergoing primary PCI. Noteworthy, DES use independently predicts a lower risk of TLR and definite ST.