Five-Year Survival in Patients with ST-Segment Elevation Myocardial Infarction According to Modalities of Reperfusion Therapy: The French Registry on Acute ST-Elevation and Non-ST-Elevation Myocardial Infarction (FAST-MI) 2005 Cohort
Background—Although primary percutaneous coronary intervention (pPCI) is the preferred reperfusion method for ST-elevation myocardial infarction (STEMI), it remains difficult to implement in many areas, and fibrinolytic therapy is still widely used.
Methods and Results—We assessed 5-year mortality in STEMI patients from the French registry of Acute ST-elevation or non-ST elevation Myocardial Infarction (FAST-MI) 2005 according to use and type of reperfusion therapy. Of 1492 STEMI patients with first call ≤12 hours from onset, 447 (30%) received fibrinolysis (66% pre-hospital; 97% with subsequent angiography, 84% with subsequent PCI), 583 (39%) had pPCI and 462 (31%) received no reperfusion. Crude 5-year survival was 88% for fibrinolytic-based strategy, 83% for pPCI and 59% for no reperfusion. Adjusted hazard ratios (95% confidence interval) for 5-year death were: 0.73 (0.50-1.06) for fibrinolysis versus pPCI, 0.57 (0.36-0.88) for pre-hospital fibrinolysis versus pPCI, and 0.63 (0.34-0.91) for fibrinolysis vs pPCI beyond 90 minutes of call in patients having called ≤180 minutes from onset. In propensity score matched populations, however, survival rates were not significantly different for fibrinolysis and pPCI, both in the whole population (88% lysis, 85% pPCI), and in the population seen early (87% fibrinolysis, 85% pPCI beyond 90 minutes from call).
Conclusions—In a real world setting, on a nationwide scale, a pharmaco-invasive strategy constitutes a valid alternative to pPCI, with 5-year survival at least equivalent to the reference reperfusion method.
Clinical Trial Registration Information—ClinicalTrials.gov number, NCT00673036.
- primary percutaneous coronary intervention
- ST-segment elevation myocardial infarction
- long-term outcome
- Received August 28, 2013.
- Revision received January 9, 2014.
- Accepted January 31, 2014.