Abstract 319: Prehospital Indication of Reperfusion in STEMI Patients and 1-Month Mortality
The indication of reperfusion at first medical contact (RFMC), proceeding directly to Cath-Lab (DCL) or, if not possible, performing pre-hospital thrombolisys on site (PhT), is a key action for STEMI patients. Our objective is to analyse if changes in RFMC are associated with one-month mortality in STEMI patients.
Methods: Retrospective observational study of two periods, P1 (Jan2001-Dec03) and P2 (Jan2005-May2009), from a continuous pre-hospital registry of patients with STEMI. Patients were followed up in-hospital and one month later. Univariate analysis to compare both periods and logistic regression for one-month mortality (from in-hospital admission to one month later).
Results: Total patients included 5522 (2248 P1 and 3274 P2). Univariate analysis (P1 vs P2) found significant differences in (%): age (64.3 vs 63.5, p=0.032), dyslipidemia (33.6 vs 36.7, p=0.02), hypertension (48.4 vs 53.1, p=0.01), history of angina (14.9 vs 11.1, p<0.0001), history of AMI (16.4 vs 13, p=0.001), hypotension (systolic blood pressure<90 mm Hg) (15.2 vs 13.3, p=0.049), Killip>I (19 vs 12.7, p<0.0001), onset-symptoms-call <60 min. (56.5 vs 60.1, p=0.01), PhT (20.8 vs 40.4, p<0.0001), DCL (0 vs 7.1, p<0.0001), in-hospital thrombolysis (46.8 16.4, p<0.0001) primary PCI (4.1 vs 17.5, p<0.0001), rescue PCI (4.3 vs 12, p<0.0001), PCI during hospital admission (16.9 vs 29.8, p<0.0001), RFMC (20.8 vs 47.5, p<0.0001),one-month mortality (18.8 vs 13.8 p<0.0001). The logistic regression in table 1. After adjust for clinical conditions and any PCI treatment preformed, RFMC was associated with less one-month mortality.
Conclusions: There were significant increases of RFMC and percentages of PCI throughout the process in P2. Despite the fact of worst clinical conditions of P1 patients, one-month mortality decreased in P2. RFMC was associated to one-month mortality reduction in STEMI patients.
- © 2012 by American Heart Association, Inc.