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Reperfusion therapy in the acute management of ST‐segment‐elevation myocardial infarction in Australia: findings from the ACACIA registry

Objective: To describe the contemporary management and outcomes of patients presenting with ST‐segment‐elevation myocardial infarction (STEMI) in Australia. Design, participants and setting: Observational analysis of data for patients who presented with suspected STEMI and enrolled in the Australian...

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Bibliographic Details
Published in:Medical journal of Australia 2010-11, Vol.193 (9), p.496-501
Main Authors: Huynh, Luan T, Rankin, Jamie M, Tideman, Phil, Brieger, David B, Erickson, Matthew, Markwick, Andrew J, Astley, Carolyn, Kelaher, David J, Chew, Derek P B
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Language:English
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Summary:Objective: To describe the contemporary management and outcomes of patients presenting with ST‐segment‐elevation myocardial infarction (STEMI) in Australia. Design, participants and setting: Observational analysis of data for patients who presented with suspected STEMI and enrolled in the Australian Acute Coronary Syndrome Prospective Audit from 1 November 2005 to 31 July 2007. Main outcome measures: Factors associated with use of reperfusion therapy and timely use of reperfusion therapy, and the effects of reperfusion on mortality. Results: In total, 755 patients had suspected STEMI. Median time to presentation was 105 minutes (IQR, 60–235 minutes). Reperfusion therapy was used in 66.9% of patients (505/755), and timely reperfusion therapy in 23.1% (174/755). Thombolysis was administered in 39.2% of those who received reperfusion therapy (198/505), while 60.8% (307/505) received primary percutaneous intervention. Cardiac arrest (OR, 2.83; P = 0.001) and treatment under the auspices of a cardiology unit (OR, 2.14; P = 0.02) were associated with use of reperfusion therapy. A normal electrocardiogram on presentation (OR, 0.42; P = 0.01), left bundle branch block (OR, 0.18; P = 0.001), acute pulmonary oedema (OR, 0.34; P < 0.01), history of diabetes (OR, 0.54; P < 0.01), and previous lesion on angiogram of > 50% (OR, 0.51; P = 0.001) were associated with not using reperfusion. Inhospital mortality was 4.0% (30/755), mortality at 30 days was 4.8% (36/755), and mortality at 1 year was 7.8% (59/755). Receiving reperfusion therapy of any kind was associated with decreased 12‐month mortality (hazard ratio [HR], 0.44; 95% CI, 0.25–0.78; P < 0.01). Timely reperfusion was associated with a reduction in mortality of 78% (HR, 0.22; P = 0.04). There were no significant differences in early and late mortality in rural patients compared with metropolitan patients (P = 0.66). Conclusion: Timely reperfusion, not the modality of reperfusion, was associated with significant outcome benefits. Australian use of timely or any reperfusion remains poor and incomplete.
ISSN:0025-729X
1326-5377
DOI:10.5694/j.1326-5377.2010.tb04031.x