Do We Reperfuse Those in Most Need? Clinical Characteristics of ST-Elevation Myocardial Infarction Patients Receiving Reperfusion Therapy in the Countrywide Registry HELIOS

作者：Pipilis Athanasios^*; Andrikopoulos George; Lekakis John; Gotsis Alexandros; Oikonmou Konstantinos; Toli Konstantina; Kyrpizidis Christos; Lambropoulos Stylianos; Stefanatos Leandros; Goumas Georgios; Kochiadakis George; Koutsogiannis Nikolaos; Kassimatis Antonios; Kogias Ioannis; Kartalis Athanasios; Kostopoulos Vasilios; Goudevenos John

来源：Hellenic Journal of Cardiology, 2010, 51(6): 486-491.

• Acute myocardial infarction
• primary PCI
• fibrinolysis
• registry

Introduction: We analysed the clinical profile of patients with an ST-elevation myocardial infarction (STEMI) who arrived in hospital within 12 hrs from pain onset and either received reperfusion therapy (PCI or fibrinolytic therapy) or remained without reperfusion.
Methods: The Hellenic Infarction Observation Study (HELIOS) was a countrywide registry of acute myocardial infarction, conducted during 2005-2006. The registry enrolled 1840 patients with myocardial infarction from 31 hospitals, with a proportional representation of all types of hospitals and all geographical areas.
Results: Of 870 patients with STEMI who were admitted within 12 hrs from pain onset, Group A received no reperfusion (n=289, 33.2%), group B underwent primary PCI (n=84, 9.7%) and group C received fibrinolysis (n=497, 57.1%). In groups A, B and C, respectively, mean age was 73 +/- 13, 61 +/- 12 and 62 +/- 13 years (p<0.001). The prevalence of female sex was 33%, 14%, 18%, of diabetes 40%, 23%, 21%, of prior MI 23%, 10%, 11% and of Killip class 2-4 at admission 32%, 11%, 13%, respectively (all p<0.001). In a multivariate analysis, advanced Killip class, age, diabetes and pain to admission time >3 hrs were all independent variables related to no reperfusion therapy.
Conclusion: Reperfusion therapies are applied to relatively lower-risk patients. If a survival advantage is to be expected at the national level, more high-risk patients, such as the elderly, women, diabetics, and mainly those with advanced Killip class, should be considered for reperfusion strategies.

• 出版日期2010-12