Elsevier

Heart, Lung and Circulation

Volume 25, Issue 2, February 2016, Pages 132-139
Heart, Lung and Circulation

Original Article
Characteristics and Clinical Course of STEMI Patients who Received no Reperfusion in the Australia and New Zealand SNAPSHOT ACS Registry

https://doi.org/10.1016/j.hlc.2015.08.004Get rights and content

Background

Cohort studies of STEMI patients have reported that over 30% receive no reperfusion. Barriers to greater use of reperfusion in STEMI patients require further elucidation.

Methods

We collected data on STEMI patients with no reperfusion as part of the SNAPSHOT ACS Registry, which recruited consecutive ACS patients in 478 hospitals throughout Australia and New Zealand during 14-27 May 2012.

Results

Of 4387 patients enrolled, 419 were diagnosed with STEMI. Primary PCI (PPCI) was performed in 160 (38.2%), fibrinolysis was used in 105 (25.1%), and 154 (36.7%) had no reperfusion. Patients with no reperfusion had a mean age of 70.3±15.0 years compared with 63.1±13.5 in the reperfusion group (p<0.0001). There were more females in the no reperfusion group (37.1% v 23.0% p=0.002) and they were significantly more likely to have prior PCI or CABG, heart failure, atrial fibrillation, chronic kidney disease and other vascular disease, and to be nursing home residents (all p<0.05). Patients without reperfusion had a significantly higher mortality in hospital (11.7% v 4.9%, p=0.011). In 370 patients who presented within 12 hours, 28 had early angiography without PCI, which was considered an attempt at reperfusion. Therefore reperfusion was attempted in 293 of 370 eligible patients (79.2%).

Conclusion

Of consecutive STEMI patients, 36.7% did not receive any reperfusion and they had a higher risk of death in hospital. In eligible patients, reperfusion was attempted in 79.2%. National strategies to encourage earlier medical contact and greater use of reperfusion in eligible patients may lead to better outcomes.

Section snippets

Background

The use of reperfusion therapy in patients presenting with STEMI within 12 hours of symptom onset, is supported by some of the most powerful evidence in medicine, which has led to these therapies being given the highest levels of recommendations in international treatment guidelines [1], [2]. Primary PCI is the preferred treatment strategy if available in a timely period after patient presentation, but fibrinolytic therapy remains an effective and recommended strategy in many hospitals around

Study Design and Organisation

The SNAPSHOT ACS study was a prospective audit of consecutive patients admitted to 478 hospitals in Australia and New Zealand with suspected ACS during a two-week period. It was developed as a collaborative quality improvement initiative between the Cardiac Society of Australia and New Zealand, the Heart Foundation of Australia, the Australian Commission on Safety and Quality in Health Care, the George Institute for Global Health, and health networks or state governments in New South Wales,

Results

The SNAPSHOT ACS Registry enrolled 4387 patients, 419 of whom were diagnosed with STEMI. Primary PCI (PPCI) was performed in 160 patients (38.1%), fibrinolysis was administered in 105 (25.1%), and 154 (36.8%) did not receive reperfusion therapy (Figure 1). Forty-nine patients (11.7%) presented 12 hours or more after the onset of symptoms and were therefore not eligible for reperfusion therapy.

Discussion

The SNAPSHOT ACS Registry is the most broadly inclusive audit of ACS treatment in Australia and New Zealand with 4387 patients enrolled in a two-week period. This provided a unique opportunity to analyse reperfusion therapy for patients diagnosed with STEMI. We found that among 419 STEMI patients, 36.8% did not receive any reperfusion therapy.

However, among this cohort 28 patients underwent coronary angiography within 12 hours of symptom onset, but did not have primary PCI. This group of

Conclusions

The SNAPSHOT ACS Registry has indicated a small improvement in the proportion of STEMI patients with actual or attempted reperfusion. However, it has also highlighted that despite wider availability of PPCI, a considerable proportion of STEMI patients in Australia and New Zealand did not receive reperfusion therapy. In these patients almost a third presented after 12 hours. Those who did not receive reperfusion were generally older with complex comorbidities, and achieving an increase in the

Funding

The SNAPSHOT ACS study was supported in part by: The Cardiac Society of Australia and New Zealand; The Heart Foundation of Australia; The Agency for Clinical Innovation (NSW); the Victorian Cardiac Clinical Network; the Queensland Cardiac Clinical Network; the Western Australian Cardiac Clinical Network; and the South Australian Cardiac Clinical Network. The study was endorsed by the Australian Commission for Quality and Safety in Health Care.

Declaration of conflicting interests

Derek P. Chew: lecture fees AstraZeneca Australia; educational programme: Heart.org, John French: Advisory Board Membership Sanofi Aventis Australia, AstraZeneca Australia, Eli Lilly Australia and Boehringer Ingelheim; Grant In Aid; The Medicines Company. Chris Hammett: Consultancy Bayer Australia and Eli Lilly Australia; lecture fees Boehringer Ingelheim and Eli Lilly Australia; travel assistance AstraZeneca Australia, Bayer Australia, Boehringer Ingelheim Australia and Eli Lilly Australia,

Acknowledgements

We acknowledge the work of investigators in 478 hospitals throughout Australia and New Zealand who recruited patients for the SNAPSHOT ACS Registry.

References (19)

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