Abstract 2399: Low Hospital Mortality Of Acute Myocardial Infarction In Cslinical Practice Due To Optimized Guideline Oriented Treatment: Results Of The Optami-registry
Background: Hospital mortality of STEMI in recent randomized trials as ASSENT IV ranges between 3.5 and 6.0%. Although registry data have shown a constant improvement of myocardial infarction outcome over the past years due to better implementation of guidelines for the management of acute myocardial infarction, hospital mortality in clinical practice still was much higher than in the selected patient population of randomized trials. Can ongoing registries in clinical practice as quality assurance programmes further reduce hospital mortality of acute myocardial infarction?
Methods: The OPTAMI Register (Optimized Therapy of Acute Myocardial Infarction) enrols consecutive patients with STEMI or NSTEMI in 33 Centres (27 with cathlab facilities) in Germany to document patient characteristics, acute therapy as well as hospital outcome. All centres are provided benchmark reports for internal quality control.
Results: Out of 1139 enrolled patients, 629 (55%) presented with STEMI and 510 (45%) with NSTEMI. Patients with NSTEMI were older, more often female and had a significantly higher prevalence of relevant comorbidities. OPTAMI documented an extraordinary high rate of primary PCI in STEMI as well as a high rate of early invasive strategy with PCI <48h in NSTEMI. In both groups, adherence to guidelines for the acute adjunctive medical treatment including antiplatelet therapy, betablockers, ACE-inhibitors and statins was higher than ever documented in any German MI registry. Hospital mortality was 4.0% in consecutive patients with STEMI and 3.9% in consecutive patients with NSTEMI.
Conclusion: Preliminary data of the ongoing OPTAMI Registry demonstrate that in selected cnetres (mainly with cath lab facilities) hospital mortality in clinical practice can be reduced to levels of randomised controlled trials by adherence to practice guidelines for the management of acute myocardial infarctions.