In-hospital mortality after ST-segment elevation myocardial infarction according to reperfusion therapy Mortalidad intrahospitalaria en hombres y mujeres según terapias de reperfusión en infarto agudo del miocardio con supradesnivel del ST

Prieto, J. C.; Sanhueza C.; Martínez N.; Nazzal C.; Cavada, G; Corbalan, R; Lanas F.; Bartolucci J.; Campos P.; Gatica, M.; Gaete P.; Bustos C.; Araya M.V.; Cotoras J.A.; Bonacic F.; et. al.

Keywords: model, models, heart, therapy, mortality, risk, infarction, trial, treatment, multicenter, activator, angioplasty, humans, human, male, agents, aged, agent, outcome, tissue, sex, female, streptokinase, transluminal, article, coronary, difference, factor, plasminogen, statistical, clinical, factors, study, hospital, percutaneous, middle, comparative, Myocardial, Angioplasty,, Transluminal,, fibrinolytic, Logistic, Thrombolytic


Background: Primary angioplasty is considered the best reperfusion therapy in the treatment of ST-segment elevation myocardial infarction (STEMI). However, thrombolysis is the reperfusion method most commonly used, due to its wide availability, reduced costs and ease of administration. Aim: To compare in-hospital mortality in STEMI patients according to reperfusion therapy. Material and Methods: Patients admitted to Chilean hospitals participating in the GEMI network, from 2001 to 2005, with STEMI were included. They were divided in three groups: a) treated with thrombolytics, b) treated with primary angioplasty, c) without reperfusion procedure. In-hospital mortality according to gender, was analized in each group, using a logistic regression method, to assess risk factors associated with mortality. Results: We included 3,255 patients. Global mortality was 9.9% (7.5% in men and 16.7% in women, p <0.001). Mortality in patients treated with thrombolytics, was 10.2% (7.6% in men and 18.7% in women, p <0.01). The figure for patients treated with primary angioplasty, was 4.7% (2.5% in men and 13% in women, p <0.01), and in patients without reperfusion, was 11.6% (9.8% in men and in 15.4% women, p <0.01). In each group women were older, had a higher prevalence of hypertension and a higher percentage of Killip 3-4 infarctions. Logistic regression showed that angioplasty, compared with no reperfusion, was associated with a reduced mortality only in men. The use of thrombolytics in women was associated with a higher mortality. Conclusions: Primary angioplasty was the reperfusion therapy associated to the lower mortality in STEMI. Use of thrombolytics in women was associated with a higher mortality rate than in non reperfused women.

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Título de la Revista: REVISTA MEDICA DE CHILE
Volumen: 136
Número: 2
Editorial: Sociedad Médica de Santiago
Fecha de publicación: 2008
Página de inicio: 143
Página final: 150