Objective: To document the trends in reperfusion therapy for ST segment elevation myocardial infarction(STEMI) in Switzerland. Design: National prospective multicentre registry, AMIS Plus(acute myocardial infarction a...Objective: To document the trends in reperfusion therapy for ST segment elevation myocardial infarction(STEMI) in Switzerland. Design: National prospective multicentre registry, AMIS Plus(acute myocardial infarction and unstable angina in Switzerland), of patients admitted with acute coronary syndromes. Setting: 54 hospitals of varying size and capability in Switzerland. Patients: 7098 of 11 845 AMIS Plus patients who presented with ST segment elevation or left bundle branch block on the ECG at admission. Main outcome measures: In-hospital mortality and its predictors at admission by multivariate analysis. Results: The proportion of patients treated by primary percutaneous coronary intervention(PCI) progressively increased from 1997 to 2002, while the proportion with thrombolysis or no reperfusion decreased(from 8.0%to 43.1%, from 47.2%to 25.0%, and from 44.8%to 31.4%, respectively). Overall in-hospital mortality decreased over the study period from 12.2%to 6.7%(p< 0.001). Main in-hospital mortality predictors by multivariate analysis were primary PCI(odds ratio(OR) 0.52, 95%confidence interval(CI) 0.33 to 0.81), thrombolysis(OR 0.63, 95%CI 0.47 to 0.83), and Killip class III(OR 3.61, 95%CI 2.49 to 5.24) and class IV(OR 5.97, 95%CI 3.51 to 10.17) at admission. When adjusted for the year, multivariate analysis did not show PCI to be significantly superior to thrombolysis for in-hospital mortality(OR 1.2 for PCI better, 95%CI 0.8 to 1.9, p=0.42). Conclusion: Primary PCI has become the preferred mode of reperfusion for STEMI since 2002 in Switzerland, whereas use of intravenous thrombolysis has decreased from 1997 to 2002. Furthermore, there was a major reduction of in-hospital mortality over the same period.展开更多
文摘Objective: To document the trends in reperfusion therapy for ST segment elevation myocardial infarction(STEMI) in Switzerland. Design: National prospective multicentre registry, AMIS Plus(acute myocardial infarction and unstable angina in Switzerland), of patients admitted with acute coronary syndromes. Setting: 54 hospitals of varying size and capability in Switzerland. Patients: 7098 of 11 845 AMIS Plus patients who presented with ST segment elevation or left bundle branch block on the ECG at admission. Main outcome measures: In-hospital mortality and its predictors at admission by multivariate analysis. Results: The proportion of patients treated by primary percutaneous coronary intervention(PCI) progressively increased from 1997 to 2002, while the proportion with thrombolysis or no reperfusion decreased(from 8.0%to 43.1%, from 47.2%to 25.0%, and from 44.8%to 31.4%, respectively). Overall in-hospital mortality decreased over the study period from 12.2%to 6.7%(p< 0.001). Main in-hospital mortality predictors by multivariate analysis were primary PCI(odds ratio(OR) 0.52, 95%confidence interval(CI) 0.33 to 0.81), thrombolysis(OR 0.63, 95%CI 0.47 to 0.83), and Killip class III(OR 3.61, 95%CI 2.49 to 5.24) and class IV(OR 5.97, 95%CI 3.51 to 10.17) at admission. When adjusted for the year, multivariate analysis did not show PCI to be significantly superior to thrombolysis for in-hospital mortality(OR 1.2 for PCI better, 95%CI 0.8 to 1.9, p=0.42). Conclusion: Primary PCI has become the preferred mode of reperfusion for STEMI since 2002 in Switzerland, whereas use of intravenous thrombolysis has decreased from 1997 to 2002. Furthermore, there was a major reduction of in-hospital mortality over the same period.
