Primary percutaneous intervention of ST-elevation myocardial infarction in Austria: Results from the Austrian acute PCI registry 2005–2007

• DOI: 10.1007/s00508-010-1352-y
• Publication Date: 2010-05-19T09:16:20Z
• Authors: Jakob Dörler; Hannes Franz Alber; Johann Altenberger; Gerhard Bonner; Werner Benzer; Georg Grimm; Kurt Huber; Lalit Kaltenbach; Karl-Peter Pfeiffer; Herwig Schuchlenz; Peter Siostrzonek; Gerald Zenker; Otmar Pachinger; Franz Weidinger
• Keywords: Male; Quality Assurance, Health Care; Myocardial Infarction; Middle Aged; Coronary Angiography; Prognosis; Combined Modality Therapy; Community Networks; 3. Good health; Electrocardiography; 03 medical and health sciences; Outcome and Process Assessment, Health Care; 0302 clinical medicine; Fibrinolytic Agents; Austria; Time and Motion Studies; Humans; Female; Hospital Mortality; Registries; Angioplasty, Balloon, Coronary; Aged

Primary percutaneous coronary intervention (PPCI) has become the preferred reperfusion strategy in ST-elevation myocardial infarction (STEMI). Implementation of networks of care and registries providing continuous quality assessment are key components for optimal management in patients with STEMI.To analyze procedural success and in-hospital outcome of interventional therapy of STEMI in Austria.We evaluated a total number of 4016 consecutive STEMI patients registered in the first three years after implementation of the Austrian acute PCI registry in January 2005.The rate of PPCI as an indication for acute coronary intervention increased from 83.5% in 2005 to 92.4% in 2007 (P < 0.0001). During this period the median door-to-balloon time decreased from 60.0 (40.0-90.0) min to 53.0 (30.0-80.0) min (P = 0.012). The percentage of patients receiving adequate adjunctive antithrombotic therapy with ASA/heparin and clopidogrel significantly increased (78.8-85.1% and 67.8-90.3%, respectively; P < 0.001). Overall in-hospital mortality was 9.6% in rescue PCI, 6.4% in facilitated PCI and 5.1% in PPCI. On multivariate analysis, cardiogenic shock (OR: 20.21, 95% CI: 12.21-33.44, P < 0.001), resuscitation (OR: 2.62, 95% CI: 1.47-4.69, P = 0.01), age (OR: 1.04, 95% CI: 1.02-1.06, P < 0.001) and angiographic success (OR: 5.93, 95% CI: 3.33-10.57, P < 0.001) were independent predictors of in-hospital death.Continuous nationwide efforts to establish regional networks for STEMI treatment in the years 2005-2007 led to a decrease in door-to-balloon time, improved adjunctive antithrombotic therapy and an in-hospital mortality of 5%. Results of interventional STEMI treatment in Austria are in accordance with current guidelines and with other contemporary registries.