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Heart. 2005 July; 91(7): 882–888.
PMCID: PMC1769002
Copyright © Copyright 2005 by Heart
Trends in reperfusion therapy of ST segment elevation myocardial infarction in Switzerland: six year results from a nationwide registry
A-A Fassa,1 P Urban,1 D Radovanovic,2 N Duvoisin,2 J-M Gaspoz,3 J-C Stauffer,4 P Erne,5 and for the AMIS Plus Investigators
1Cardiovascular Department, La Tour Hospital, Geneva, Switzerland
2Institute of Social and Preventive Medicine, Zurich University, Zurich, Switzerland
3Department of Internal Medicine, Geneva University Hospitals, Geneva, Switzerland
4Division of Cardiology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
5Division of Cardiology, Kantonsspital, Lucerne, Switzerland
Correspondence to:
Dr Philip Urban
Cardiovascular Department, La Tour Hospital, Avenue Maillard 1, 1217 Geneva, Switzerland; philip.urban/at/latour.ch
Accepted September 13, 2004.
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Abstract
Objective: To document the trends in reperfusion therapy for ST segment elevation myocardial infarction (STEMI) in Switzerland.
Design: National prospective multicentre registry, AMIS Plus (acute myocardial infarction and unstable angina in Switzerland), of patients admitted with acute coronary syndromes.
Setting: 54 hospitals of varying size and capability in Switzerland.
Patients: 7098 of 11 845 AMIS Plus patients who presented with ST segment elevation or left bundle branch block on the ECG at admission.
Main outcome measures: In-hospital mortality and its predictors at admission by multivariate analysis.
Results: The proportion of patients treated by primary percutaneous coronary intervention (PCI) progressively increased from 1997 to 2002, while the proportion with thrombolysis or no reperfusion decreased (from 8.0% to 43.1%, from 47.2% to 25.6%, and from 44.8% to 31.4%, respectively). Overall in-hospital mortality decreased over the study period from 12.2% to 6.7% (p < 0.001). Main in-hospital mortality predictors by multivariate analysis were primary PCI (odds ratio (OR) 0.52, 95% confidence interval (CI) 0.33 to 0.81), thrombolysis (OR 0.63, 95% CI 0.47 to 0.83), and Killip class III (OR 3.61, 95% CI 2.49 to 5.24) and class IV (OR 5.97, 95% CI 3.51 to 10.17) at admission. When adjusted for the year, multivariate analysis did not show PCI to be significantly superior to thrombolysis for in-hospital mortality (OR 1.2 for PCI better, 95% CI 0.8 to 1.9, p = 0.42).
Conclusion: Primary PCI has become the preferred mode of reperfusion for STEMI since 2002 in Switzerland, whereas use of intravenous thrombolysis has decreased from 1997 to 2002. Furthermore, there was a major reduction of in-hospital mortality over the same period.
Keywords: ST segment elevation myocardial infarction, percutaneous coronary intervention, registry, thrombolysis, reperfusion
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