Reperfusion therapy in the acute management of ST-segment-elevation myocardial infarction in Australia: Findings from the ACACIA registry

Luan T. Huynh, Jamie M. Rankin, Phil Tideman, David B. Brieger, Matthew Erickson, Andrew J. Markwick, Carolyn Astley, David J. Kelaher, Derek P B Chew

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Abstract

Objective: To describe the contemporary management and outcomes of patients presenting with ST-segment-elevation myocardial infarction (STEMI) in Australia. Design, participants and setting: Observational analysis of data for patients who presented with suspected STEMI and enrolled in the Australian Acute Coronary Syndrome Prospective Audit from 1 November 2005 to 31 July 2007. Main outcome measures: Factors associated with use of reperfusion therapy and timely use of reperfusion therapy, and the effects of reperfusion on mortality. Results: In total, 755 patients had suspected STEMI. Median time to presentation was 105 minutes (IQR, 60-235 minutes). Reperfusion therapy was used in 66.9% of patients (505/755), and timely reperfusion therapy in 23.1% (174/755). Thombolysis was administered in 39.2% of those who received reperfusion therapy (198/505), while 60.8% (307/505) received primary percutaneous intervention. Cardiac arrest (OR, 2.83; P = 0.001) and treatment under the auspices of a cardiology unit (OR, 2.14; P = 0.02) were associated with use of reperfusion therapy. A normal electrocardiogram on presentation (OR, 0.42; P = 0.01), left bundle branch block (OR, 0.18; P = 0.001), acute pulmonary oedema (OR, 0.34; P < 0.01), history of diabetes (OR, 0.54; P < 0.01), and previous lesion on angiogram of > 50% (OR, 0.51; P = 0.001) were associated with not using reperfusion. Inhospital mortality was 4.0% (30/755), mortality at 30 days was 4.8% (36/755), and mortality at 1 year was 7.8% (59/755). Receiving reperfusion therapy of any kind was associated with decreased 12-month mortality (hazard ratio [HR], 0.44; 95% CI, 0.25-0.78; P < 0.01). Timely reperfusion was associated with a reduction in mortality of 78% (HR, 0.22; P = 0.04). There were no significant differences in early and late mortality in rural patients compared with metropolitan patients (P = 0.66). Conclusion: Timely reperfusion, not the modality of reperfusion, was associated with significant outcome benefits. Australian use of timely or any reperfusion remains poor and incomplete.

LanguageEnglish
Pages496-501
Number of pages6
JournalMedical Journal of Australia
Volume193
Issue number9
Publication statusPublished - 1 Nov 2010
Externally publishedYes

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Huynh, Luan T. ; Rankin, Jamie M. ; Tideman, Phil ; Brieger, David B. ; Erickson, Matthew ; Markwick, Andrew J. ; Astley, Carolyn ; Kelaher, David J. ; Chew, Derek P B. / Reperfusion therapy in the acute management of ST-segment-elevation myocardial infarction in Australia : Findings from the ACACIA registry. In: Medical Journal of Australia. 2010 ; Vol. 193, No. 9. pp. 496-501.
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title = "Reperfusion therapy in the acute management of ST-segment-elevation myocardial infarction in Australia: Findings from the ACACIA registry",
abstract = "Objective: To describe the contemporary management and outcomes of patients presenting with ST-segment-elevation myocardial infarction (STEMI) in Australia. Design, participants and setting: Observational analysis of data for patients who presented with suspected STEMI and enrolled in the Australian Acute Coronary Syndrome Prospective Audit from 1 November 2005 to 31 July 2007. Main outcome measures: Factors associated with use of reperfusion therapy and timely use of reperfusion therapy, and the effects of reperfusion on mortality. Results: In total, 755 patients had suspected STEMI. Median time to presentation was 105 minutes (IQR, 60-235 minutes). Reperfusion therapy was used in 66.9{\%} of patients (505/755), and timely reperfusion therapy in 23.1{\%} (174/755). Thombolysis was administered in 39.2{\%} of those who received reperfusion therapy (198/505), while 60.8{\%} (307/505) received primary percutaneous intervention. Cardiac arrest (OR, 2.83; P = 0.001) and treatment under the auspices of a cardiology unit (OR, 2.14; P = 0.02) were associated with use of reperfusion therapy. A normal electrocardiogram on presentation (OR, 0.42; P = 0.01), left bundle branch block (OR, 0.18; P = 0.001), acute pulmonary oedema (OR, 0.34; P < 0.01), history of diabetes (OR, 0.54; P < 0.01), and previous lesion on angiogram of > 50{\%} (OR, 0.51; P = 0.001) were associated with not using reperfusion. Inhospital mortality was 4.0{\%} (30/755), mortality at 30 days was 4.8{\%} (36/755), and mortality at 1 year was 7.8{\%} (59/755). Receiving reperfusion therapy of any kind was associated with decreased 12-month mortality (hazard ratio [HR], 0.44; 95{\%} CI, 0.25-0.78; P < 0.01). Timely reperfusion was associated with a reduction in mortality of 78{\%} (HR, 0.22; P = 0.04). There were no significant differences in early and late mortality in rural patients compared with metropolitan patients (P = 0.66). Conclusion: Timely reperfusion, not the modality of reperfusion, was associated with significant outcome benefits. Australian use of timely or any reperfusion remains poor and incomplete.",
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Huynh, LT, Rankin, JM, Tideman, P, Brieger, DB, Erickson, M, Markwick, AJ, Astley, C, Kelaher, DJ & Chew, DPB 2010, 'Reperfusion therapy in the acute management of ST-segment-elevation myocardial infarction in Australia: Findings from the ACACIA registry', Medical Journal of Australia, vol. 193, no. 9, pp. 496-501.

Reperfusion therapy in the acute management of ST-segment-elevation myocardial infarction in Australia : Findings from the ACACIA registry. / Huynh, Luan T.; Rankin, Jamie M.; Tideman, Phil; Brieger, David B.; Erickson, Matthew; Markwick, Andrew J.; Astley, Carolyn; Kelaher, David J.; Chew, Derek P B.

In: Medical Journal of Australia, Vol. 193, No. 9, 01.11.2010, p. 496-501.

Research output: Contribution to journalArticle

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T1 - Reperfusion therapy in the acute management of ST-segment-elevation myocardial infarction in Australia

T2 - The Medical journal of Australia

AU - Huynh, Luan T.

AU - Rankin, Jamie M.

AU - Tideman, Phil

AU - Brieger, David B.

AU - Erickson, Matthew

AU - Markwick, Andrew J.

AU - Astley, Carolyn

AU - Kelaher, David J.

AU - Chew, Derek P B

PY - 2010/11/1

Y1 - 2010/11/1

N2 - Objective: To describe the contemporary management and outcomes of patients presenting with ST-segment-elevation myocardial infarction (STEMI) in Australia. Design, participants and setting: Observational analysis of data for patients who presented with suspected STEMI and enrolled in the Australian Acute Coronary Syndrome Prospective Audit from 1 November 2005 to 31 July 2007. Main outcome measures: Factors associated with use of reperfusion therapy and timely use of reperfusion therapy, and the effects of reperfusion on mortality. Results: In total, 755 patients had suspected STEMI. Median time to presentation was 105 minutes (IQR, 60-235 minutes). Reperfusion therapy was used in 66.9% of patients (505/755), and timely reperfusion therapy in 23.1% (174/755). Thombolysis was administered in 39.2% of those who received reperfusion therapy (198/505), while 60.8% (307/505) received primary percutaneous intervention. Cardiac arrest (OR, 2.83; P = 0.001) and treatment under the auspices of a cardiology unit (OR, 2.14; P = 0.02) were associated with use of reperfusion therapy. A normal electrocardiogram on presentation (OR, 0.42; P = 0.01), left bundle branch block (OR, 0.18; P = 0.001), acute pulmonary oedema (OR, 0.34; P < 0.01), history of diabetes (OR, 0.54; P < 0.01), and previous lesion on angiogram of > 50% (OR, 0.51; P = 0.001) were associated with not using reperfusion. Inhospital mortality was 4.0% (30/755), mortality at 30 days was 4.8% (36/755), and mortality at 1 year was 7.8% (59/755). Receiving reperfusion therapy of any kind was associated with decreased 12-month mortality (hazard ratio [HR], 0.44; 95% CI, 0.25-0.78; P < 0.01). Timely reperfusion was associated with a reduction in mortality of 78% (HR, 0.22; P = 0.04). There were no significant differences in early and late mortality in rural patients compared with metropolitan patients (P = 0.66). Conclusion: Timely reperfusion, not the modality of reperfusion, was associated with significant outcome benefits. Australian use of timely or any reperfusion remains poor and incomplete.

AB - Objective: To describe the contemporary management and outcomes of patients presenting with ST-segment-elevation myocardial infarction (STEMI) in Australia. Design, participants and setting: Observational analysis of data for patients who presented with suspected STEMI and enrolled in the Australian Acute Coronary Syndrome Prospective Audit from 1 November 2005 to 31 July 2007. Main outcome measures: Factors associated with use of reperfusion therapy and timely use of reperfusion therapy, and the effects of reperfusion on mortality. Results: In total, 755 patients had suspected STEMI. Median time to presentation was 105 minutes (IQR, 60-235 minutes). Reperfusion therapy was used in 66.9% of patients (505/755), and timely reperfusion therapy in 23.1% (174/755). Thombolysis was administered in 39.2% of those who received reperfusion therapy (198/505), while 60.8% (307/505) received primary percutaneous intervention. Cardiac arrest (OR, 2.83; P = 0.001) and treatment under the auspices of a cardiology unit (OR, 2.14; P = 0.02) were associated with use of reperfusion therapy. A normal electrocardiogram on presentation (OR, 0.42; P = 0.01), left bundle branch block (OR, 0.18; P = 0.001), acute pulmonary oedema (OR, 0.34; P < 0.01), history of diabetes (OR, 0.54; P < 0.01), and previous lesion on angiogram of > 50% (OR, 0.51; P = 0.001) were associated with not using reperfusion. Inhospital mortality was 4.0% (30/755), mortality at 30 days was 4.8% (36/755), and mortality at 1 year was 7.8% (59/755). Receiving reperfusion therapy of any kind was associated with decreased 12-month mortality (hazard ratio [HR], 0.44; 95% CI, 0.25-0.78; P < 0.01). Timely reperfusion was associated with a reduction in mortality of 78% (HR, 0.22; P = 0.04). There were no significant differences in early and late mortality in rural patients compared with metropolitan patients (P = 0.66). Conclusion: Timely reperfusion, not the modality of reperfusion, was associated with significant outcome benefits. Australian use of timely or any reperfusion remains poor and incomplete.

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JO - The Medical journal of Australia

JF - The Medical journal of Australia

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