0000000000012684
AUTHOR
Rudolf Schiele
Impact of prehospital delay on mortality in patients with acute myocardial infarction treated with primary angioplasty and intravenous thrombolysis.
Abstract Background In patients with acute myocardial infarction treated with thrombolysis, longer times to treatment are associated with increasingly worse clinical outcome. This relation may be different for treatment with primary angioplasty. Methods We analyzed the pooled data of the German acute myocardial infarction registries Maximal Individual Therapy in Acute Myocardial Infarction (MITRA) and Myocardial Infarction Registry (MIR) to determine the influence of prehospital delays on hospital mortality rates. Primary angioplasty was performed in 1063 patients and thrombolysis in 7552 patients. Results In patients treated with thrombolysis, in-hospital time to treatment was constantly 3…
Gender differences in acute myocardial infarction in the era of reperfusion (the MITRA registry).
There is conflicting information about gender differences in presentation, treatment, and outcome after acute ST elevation myocardial infarction (STEMI) in the era of thrombolytic therapy and primary percutaneous coronary intervention. From June 1994 to January 1997, we enrolled 6,067 consecutive patients with STEMI admitted to 54 hospitals in southwest Germany in the Maximal Individual TheRapy of Acute myocardial infarction (MITRA), a community-based registry. Women were 9 years older than men, more often had hypertension, diabetes mellitus, and congestive heart failure, and had a history of previous myocardial infarction less often. Women had a longer prehospital delay (45 minutes), had a…
Primär-Dilatation versus Thrombolyse bei Patienten mit akutem Myokardinfarkt, die nicht in randomisierte Studien eingeschlossen wurden
Die randomisierten Studien zum Vergleich der Thrombolyse und der Primar-Dilatation beim akuten Myokardinfarkt schlossen keine Patienten mit Linksschenkelblock, nichtdiagnostischem ersten Elektrokardiogramm, einer Prahospitalzeit von ≥ 12 h oder einer unbekannten Prahospitalzeit ein. Im klinischen Alltag werden jedoch haufig solche Patienten mittels Thrombolyse oder Primar-Dilatation behandelt. Um diese Patientengruppen zu beschreiben und den Einflus der Lyse und der Primar-Dilatation zu vergleichen, untersuchten wir die Daten aus der “Maximale Individuelle Optimierte Therapie beim Akuten Myokardinfarkt” (MITRA)-Studie. Bei 737 von 3308 (22,3 %) mittels Primar-Dilatation oder Lyse behandelte…
Primary percutaneous transluminal coronary angioplasty for Acute Myocardial Infarction in patients not included in randomized studies
Abstract Patients with acute myocardial infarction included in randomized trials comparing primary percutaneous transluminal coronary angioplasty (pPTCA) with thrombolysis represent a special subgroup of patients with a low event rate. Patients excluded from these trials represent a variety of different subgroups, with different patient characteristics and possibly different clinical event rates. Primary PTCA was performed in 491 consecutive patients with acute myocardial infarction in the prospective multicenter observational Maximal Individual Therapy in Acute Myocardial Infarction trial. They were divided into the following groups: group I, patients fulfilling the inclusion criteria of t…
Primary angioplasty versus intravenous thrombolysis in acute myocardial infarction: can we define subgroups of patients benefiting most from primary angioplasty?
Abstract OBJECTIVES We sought to determine the effectiveness of primary angioplasty compared with thrombolysis in clinical practice. BACKGROUND In clinical practice, primary angioplasty for the treatment of acute myocardial infarction (AMI) has not yet been proven more effective than intravenous thrombolysis, nor have subgroups of patients been identified who would perhaps benefit from primary angioplasty. METHODS The pooled data of two AMI registries—the Maximal Individual TheRapy in Acute myocardial infarction (MITRA) study and the Myocardial Infarction Registry (MIR)—were analyzed. A total of 9,906 lytic-eligible patients with AMI, with a pre-hospital delay of ≤12 h, were treated with ei…
Acute myocardial infarction occurring in versus out of the hospital: patient characteristics and clinical outcome
OBJECTIVES We describe the baseline characteristics and clinical course of patients who had an acute myocardial infarction (AMI) during their hospital stay. BACKGROUND In comparison with patients who had an AMI outside of the hospital (prehospital AMI), the data on patients who had an AMI in the hospital are poorly described. METHODS Patients with an in-hospital AMI were prospectively registered in the Southwest German Maximal Individual TheRapy in Acute myocardial infarction (MITRA) study and compared with patients with prehospital AMI. RESULTS Of 5,888 patients with AMI, 403 patients (6.8%) had an in-hospital AMI. These patients were older, more often male and sicker as compared with the …
Comparison of primary angioplasty with conservative therapy in patients with acute myocardial infarction and contraindications for thrombolytic therapy
The benefit of primary angioplasty in patients with acute myocardial infarction (AMI) and contraindications for thrombolysis compared to a conservative regimen is still unclear. Out of 5,869 patients with AMI registered by the MITRA trial, 337 (5.7%) patients had at least one strong contraindication for thrombolytic therapy. Out of these 337 patients 46 (13.6%) were treated with primary angioplasty and 276 (86.4%) were treated conservatively. Patients treated conservatively were older (70 years vs. 60 years; P = 0.001), had a higher rate of a history with chronic heart failure (14.8% vs. 4.4%; P = 0.053), a higher heart rate at admission (86 beats/min vs. 74 beats/min; P = 0.001), and a hig…