Abstract 5605: Real World Comparison of Long Term Mortality after Primary Percutanous Coronary Intervention (PPCI) versus Fibrinolysis for Acute St Elevation Myocardial Infarction: Initial Experience from the 24 Hour PPCI Program in Nova Scotia
Background Randomized controlled trials indicate that acute ST elevation myocardial infarction (STEMI) patients have better clinical outcomes if rapid, complete and stable coronary artery patency can be achieved. The Queen Elizabeth II Health Sciences Center in Halifax, Nova Scotia (QEIIHSC) commenced a 24 hour PPCI program in November 2005. This real world study compares 2 year mortality in STEMI patients treated by PPCI versus patients treated by fibrinolysis with provisional rescue PCI within Nova Scotia, Canada.
Methods This was a single center retrospective cohort study. All consecutive Nova Scotia, fibrinolytic and PPCI eligible STEMI patients presenting within 12 hours of symptom onset between July 1st 2005 and June 30th 2006 treated by PPCI at the QEIIHSC or fibrinolyis outside the QEIIHSC were included. The outcome measure was all cause mortality censored on June 30th 2007. The crude and independent association between PPCI versus fibrinolysis on mortality was estimated using a Cox regression model.
Results Data for 423 eligible patients (100% of cohort) comprised of 359/423 (85%) patients treated with fibrinolytics and 64/359 (18%) treated by PPCI were analyzed. The median follow-up was 1.4 years. The median (Q25 to Q75) door to needle times in the fibrinolytic group and corresponding door to balloon times in the PPCI group were: 0.5 (.3 to .9) and 1.5 (1.1 to 1.9) hours respectively. PPCI was associated with a consistent trend toward lower mortality versus fibrinolysis during hospitalization: 2/64 (3.1%) vs. 29/359 (8.1%), P=0.16 and at 30 days 2/64 (3.1%) vs. 32/359 (15%), P=0.12. This association was significant at 1 and 2 year follow-up: 2/64 (3.1%) vs. 41/359 (11%), P=0.043 and 2/64 (3.1%) vs. 45/359 (12%), P=0.027 respectively. This corresponded with an independent HR for 2 year mortality of: 0.1 (.01 to 0.8), p=0.03.
Conclusion Initial data from the PPCI program at the QEIIHSC in Halifax, Nova Scotia indicates that PPCI was associated significant reductions in mortality versus fibrinolysis for real world patients presenting with STEMI. This mortality reduction was achieved in the early pilot phase of a PPCI program with evolving door to balloon timelines versus an established fibrinolytic program with acceptable door to needle timelines.