Abstract 19138: Reperfusion Therapy for ST-Elevation Acute Myocardial Infarction in Eastern Europe: The ISACS-TC Registry
Introduction: Widespread availability of tertiary hospitals with catheterization facilities, although vigorously promoted, has yet to become a reality in many countries with economy in transition.
Hypothesis: To evaluate the clinical profile and mortality of patients who were hospitalized with a diagnosis of STEMI, and either received reperfusion therapy or remained without reperfusion in Eastern Europe.
Methods: Data were obtained from the International Survey of Acute Coronary Syndromes in Transitional Countries (ISACS-TC; NCT01218776) on 6690 STEMI patients admitted to 57 hospitals in 8 Eastern Europe countries (Bosnia and Herzegovina, Croatia, Kosovo, Lithuania, Macedonia, Montenegro, Romania and Serbia) from January 2010 to May 2014. The primary endpoint was in-hospital mortality. Estimates of the ORs and 95%CI were obtained by multivariable logistic regression analysis.
Results: The prevalent reperfusion strategies were: pPCI in Croatia (87.7%), Lithuania (81.1%), Macedonia ( 93.6%) and Serbia (69.1%) and fibrinolysis in Bosnia and Herzegovina (50.4%), Kosovo (22.6%), Montenegro (51.3%) and Romania (37.0%). Of the overall population, 1191 patients (17.8%) received fibrinolysis, 3547 patients (53.0%) underwent pPCI, and 1952 (29.2%) received no reperfusion therapy. The rates of non reperfused patients ranged from 1.9% to 77.4%, in Lithuania and Kosovo, respectively. Mortality rates were higher in non reperfused patient (16.0% vs. 5.3% in the pPCI group and 7.1% in fibrinolysis group). After adjustment, female sex (OR:1.26 CI: 1.08-1.47), age ≥ 65 yr (OR: 1.14 CI: 1.06-1.22), prior MI (OR: 1.82 CI:1.47-2.25), prior CABG (OR: 2.51 CI: 1.39-4.54), peripheral artery disease (OR: 2.91 CI: 1.90-4.46), Killip class ≥ 2 (OR: 1.88 CI: 1.57-2.25), and time to admission >12 h (OR: 7.12 CI: 6.09-8.32), were all independent variables associated with no reperfusion therapy.
Conclusions: A substantial number of patients are still not offered any reperfusion therapy in many countries with economy in transition. Reperfusion therapies are mostly applied to relatively lower-risk patients. Due to the dishomogeneity of centers enrolled (secondary vs. tertiary), a direct comparison between countries should be performed with caution.
Author Disclosures: E. Cenko: None. S. Kedev: None. Z. Vasiljevic: None. M. Dorobantu: None. O. Gustiene: None. I. Daullxhiu: None. B. Kneževic: None. D. Milicic: None. M. Dilic: None. D. Trninic: None. O. Manfrini: None. R. Bugiardini: None.
- © 2014 by American Heart Association, Inc.