Sammanfattning
BACKGROUND: ST-elevation myocardial infarction is treated with reperfusion, either in the form of primary percutaneous coronary intervention (PCI) or thrombolytic therapy. The choice of treatment depends on transport time to the nearest PCI centre. Norway’s geography means that thrombolytic therapy will be appropriate for many patients. Irrespective of treatment choice, it is important to avoid delays. We wished to compare the outcomes of primary PCI and thrombolytic therapy in our healthcare region and to examine whether reperfusion therapy was administered within the recommended time window.
MATERIAL AND METHOD: Using registry data and patient medical records, we compared the outcomes of primary PCI and thrombolytic therapy in cases of ST-elevation myocardial infarction in the Central Norway Regional Health Authority in the period 2015–16. The outcomes analysed were 30-day mortality, ejection fraction measured by echocardiography during the hospital stay, incidence of bleeding complications, and time from diagnosis to start of treatment.
RESULTS: The study population comprised 648 patients with ST-elevation myocardial infarction. Of these, 382 were treated with primary PCI and 266 received thrombolytic therapy. The 30-day mortality was 5.5 % in the primary PCI group and 5.6 % in the thrombolysis group (p = 1.0). There were no significant differences in ejection fraction and no cases of serious bleeding. In 45 % of the total population, reperfusion therapy was started later than recommended in guidelines.
INTERPRETATION: There was no statistically significant difference in mortality or ejection fraction when comparing primary PCI and thrombolytic therapy in an unselected population with ST-elevation myocardial infarction. Many patients experienced delayed start of treatment . It is important to take action to reduce delays at all stages of the therapeutic chain. Thrombolytic therapy should be considered when it is unclear whether transport time to a PCI centre will exceed that recommended in guidelines.