Reperfusion therapy reduces mortality rate from ST-segment-elevation myocardial infarction
Timely reperfusion therapy in patients with acute ST-segment-elevation myocardial infarction (STEMI) greatly reduces the mortality rate associated with STEMI, according to an article in the Medical Journal of Australia.
Professor Derek Chew, Professor of Cardiology at Flinders University and Regional Director of Cardiology at Flinders Medical Centre, Adelaide, and co-authors conducted a study to describe the contemporary management and outcomes of patients presenting with STEMI in Australia, and to determine the factors associated with timely reperfusion and the effects of reperfusion on mortality.
Professor Chew said that timely reperfusion, not the modality of reperfusion, was associated with significant outcome benefits. However, Australian use of timely, or any, reperfusion remains poor and incomplete.
“Our findings provide a strong case for continued audit and possible system redesign of our acute coronary syndromes management through a nationwide ongoing clinical registry,” Professor Chew said.
In an accompanying editorial in the Medical Journal of Australia Dr Ian Scott, Director of the Department of Internal Medicine and Clinical Epidemiology at the Princess Alexandra Hospital, Brisbane, reviewed the procedures involved in providing early coronary reperfusion in patients with STEMI.
Dr Scott said that, in patients with STEMI, early coronary reperfusion within 1-2 hours of symptom onset reduces the mortality rate by half. However, this benefit quickly dissipates with further delay in treatment.
He said a multifaceted approach was needed to reduce ischaemic time. This would involve educating both patients and doctors; coordinating ambulance, emergency department and cardiac catheterisation laboratory components of care; establishing integrated networks of non-PCI and PCI-capable hospitals with decisions to support and transfer processes that take patient risk and time to presentation into account; and ongoing data collection and feedback within clinical registries.
The Medical Journal of Australia is a publication of the Australian Medical Association.
The statements or opinions that are expressed in the MJA reflect the views of the authors and do not represent the official policy of the AMA unless that is so stated.
CONTACT: Prof Derek Chew 0417 372 439 / 08 8404 2001
Dr Ian Scott unavailable for interview