Impacto de la trombolisis y de la angioplastia primaria en pacientes con infarto agudo del miocardio tratados en centros hospitalarios terciarios / Mortality of patients with ST-elevation acute myocardial infarction treated with primary angioplasty or thrombolysis

ABSTRACT

Background: Primary angioplasty is the most effective treatment of ST-segment elevation acute myocardial infarction (STEMI). However, its worldwide implementation is difficult to obtain. Therefore thrombolysis continues to be the treatment most commonly used. Aim: To evaluate inhospital and long term mortality of patients with STEMI treated with thrombolysis or angioplasty, in three hospitals participating in the Chilean National Registry of Acute MI (GEMIgroup). Material and tnethods Registry of 1,634 consecutive patients with STEMI admited between 2002 and 2006. Risk was stratified using the Thrombolysis in Myocardial Infarction (TIMI) Risk Score. Hospital and log term mortalities were adjusted using logistic and Cox regression models. Results: Fifty nine percent of patients (967 patients aged 60±12 years, 77 percent males) were subjected to reperfusion therapies, 28 percent with primary angioplasty and 72 percent with thrombolysis. Hospital mortality rates among patients treated with thrombolysis and angioplasty were 10.9 percent and 5.6 percent (p =0.01), respectively The figures for long term mortality were 20.4 percent and 9.7 percent, respectively (p <0.01). Multivariate analysis confirmed the lower mortality among subjects treated with angioplasty, with an odds ratio (OR) in favor of angioplasty of 8.5 (95 percent confidence intervals (CI) 3-35) for in hospital mortality and of 4.7 (95 percent CI 2.6-8.3) for long term mortality. The higher benefits of angioplasty were observed in males, in the elderly and in patients with a TIMI score over >3. Conclusions: Hospital and long term mortality of patients with STEMI was lower among those treated with primary angioplasty. This treatment is most beneficial among males, in the elderly and in patients with a TIMI score >3.