Acute Myocardial Infarction Mortality in Continuous ARGEN-IAM-ST Registry. Its Relationship with Different Reperfusion Therapies

pp. 312-320

Abstract

Background: Reperfusion treatment is the most effective therapy to reduce ST-segment elevation acute myocardial infarction (STEMI) mortality, and its effectiveness is inversely proportional to total ischemic time. The greatest challenge is to implement its application in real life and continuously correct the deviations or barriers that arise in daily practice.

Objectives: The aim of this study was to assess mortality with different reperfusion modalities, their effectiveness and the relations hip of mortality with treatment time.

Methods: A national prospective, multicenter study was carried out including patients, with STEMI up to 36 h since symptom onset (ARGEN-IAM-ST continuous registry).

Results: A total of 2464 patients from 78 centers were included in the study from 2015 to 2019. In 88.5% of cases, patients received reperfusion treatment. Overall mortality was 8.68%; in patients with reperfusion therapy, mortality was 7.81% vs. 15.38% without reperfusion treatment (p <0.001).
Mortality was 7.51% with primary angioplasty, 9.03% with thrombolytics, 2.99% with a pharmacoinvasive strategy and 9.40% with rescue angioplasty, with no statistically significant difference between primary angioplasty and thrombolytics (OR 0.81; 95% CI 0.56-1.18, p = ns).
Deceased patients were older and with a higher proportion of women and heart failure. Reperfusion treatment and admission to the institution within 3 hours of symptom onset were associated with lower mortality. Patients with primary angioplasty who died had a longer total ischemic time (378 min vs. 285 min, p <0.001).

Conclusions: Mortality from STEMI was associated with access to reperfusion treatment and its early implementation. It was much higher in non-reperfused patients, and lower when reperfusion was carried out early within 3 hours of symptom onset. In patients treated with primary angioplasty, mortality increased with longer total ischemic time. This registry of the actual practice of infarc
tion treatment reinforces the need for a better management of the care system to reduce times and use the best timely strategy.

How to cite this article:

Charask A. Acute Myocardial Infarction Mortality in Continuous ARGEN-IAM-ST Registry. Its Relationship with Different Reperfusion Therapies. REV ARGENT CARDIOL 2021;89:312-320.

 http://dx.doi.org/10.7775/rac.v89.i4.20412