STEMI Management in Belgium

Transcription

1 STEMI Management in Belgium Results of Belgian STEMI registry Prof dr M Claeys University Hospital Antwerp Belgian Working Group of Acute cardiology

2 Lethality of AMI 2-23: MKG data N= AMI in hospital lethality: 15.9% From dr W Aelvoet, RIZIV/ENAMI

3 STEMI registry in Belgium: AIM Prospective registry of all ST elevation myocardial infarctions admitted in Belgian hospitals (critical care program A) Evaluation of predictors of in hospital mortality for STEMI in Belgium Quality assessment of critical care by means of on-line benchmark reports.

4 Minimal Data Base Patient characteristics (TIMI risk score) Reperfusion strategy In Hospital Outcome Electronic CRF

5 TIMI risk score (automatically calculated) Circulation: 2;12:231

6 Enrolment STEMI patients 1/1/27 31/12/ n= hospitals 75 hospitals with >1 pts 73

7 Percent Regional data on baseline characteristics TIMI risk score 4.4 4,4 4,3 4, ,9 4. 4, Histogram 4,2 +/- 2, >9 TIMI >>9 3.2

8 Regional data on baseline characteristics Totaal ischemic time : proportion < 4h Total ischemic time h 2-4h 4-8h 8-12h 12-24h >24h ischemic time 7

9 Regional data on Reperfusion therapy Primary PCI thromb. PPCI ResPCI facpci no rep reperfusion therapy 2

10 Evolution reperfusion therapy PCI center no reperf TT PCI No-PCI center no reperf TT PCI

11 Regional data on duration of hospital stay Duration N=182 1, Average: 7 +/- 13 d >7d: 21% 5

12 Cell Mean Cell Mean Determinants of Hospital stay All Patients alive, n= >9 Cell TIMI risk score Cell TT PCI no reperf

13 Regional data on in hospital mortality Mortality Average: 4 4 8,9% 7 3d mortility (n=384). % (vs 5.2% in hospital)

14 Global Analyis: mortality data Mortality versus TIMI risk score/ ischemic time Mortality versus reperfusion strategy Mortality versus door to balloon/needle time Mortality versus cardiac care program Mortality and gender Mortality: independent predictors

15 Mortality versus TIMI risk score , 1,5 12,5,,3 1, >9 TIMI risk

16 Mortality versus total ischaemic time treatment<4h treatment>4h no treatment 59% 35% %

17 Mortality versus Reperfusion strategy Percent Percent Percent N= 97 Trombolysis N=27 Rescue PCI N=25 PCI N= 74 Faciliated PCI N=223 No Reperfus. 555 N = 892 ( 1%)* N=729(84%) N= 555 (%) >9 TIMI risk score >9 TIMI risk score >9 TIMI risk score MORTALITY,7%. % 19% *Elective Invasive evaluation:477+25=742 ( 83%)

18 Mortality benefit PCI over TT is dependent on baseline risk profile PCI vs TT : P= >8 PCI thrombolysis InTIME II Claeys et al, Arch of Intern Med 211

19 Mortality versus door to balloon/needle time Early PCI: < min Interm PCI: -12 Late PCI: > 12 min Early TT: <3 min Interm T: 3- min Late T: > min Door-t- balloon time should be less than min to obtain lowest mortality rates!! Claeys et al, Arch of Intern Med 211

20 Percent Mortality versus Acute cardiac care program Percent PCI centre N=5471(%) No-PCI centre N=35 (4%) trombolysis: 2% trombolysis: 14% Rescue PCI: 1% Rescue PCI: % Prim facilat PCI: 93% Prim facilat PCI:71% No reperfusion: 4 % No reperfusion: 9 % >9 TIMI risk score MORTALITY %.1% 7.3%.3% >9 TIMI risk score

21 Mortality versus gender age DM Time to T<4h shock PCI/throm/no Men N= % 2 % 7% 85/1/5 Female N=223(25%) 9 * 19% * 51% * 11 % * 8/1/1 * Mortality 5.5% 11.2% * * p<.1

22 Indepedent predictors of mortality P value R (95%CI) Killip > 1 <.1 5 (4-7) CPR <.1 5 ( 4-) age < ( ) PCI vs TT No reperf.2 <,1 1.5 ( ) 2,3 (1,7-3,1) Ischemia>4h (1.3-2.) PAD <.1 1,8 ( ) female ( )

23 Conclusions The Belgian STEMI registry is the first prospective registry enroling patients from both PCI and no-pci centres. The overall in hospital mortality is.9 % and compares well with current European ACS surveys. Mortality of patients who receives reperfusion therapy within 4 hours after onset of symptoms is on average 5%. Mortality increases almost two-fold if therapy is started after 4 hours and increases even four-fold if no reperfusion therapy was given

24 Conclusions Mortality benefit of PPCI over trombolysis (. versus.7) is smaller than in previously reported randomised clinical trials. This is related, at least partly, to the selective use of trombolytic therapy mainly in low risk patients and to better outcome of thrombolytic therapy (related the high rate of subsequent invasive evaluation in Belgium. ) In the setting of STEMI networking with low threshold for invasive evaluation, the mortality of STEMI in PCI and no-pci centers is identical. Participation to the STEMI registry increases adherence to guidelines as was evidenced by a significant gradual increase in primary PCI particularly in non-pci centers.