Background/Aims: A large proportion of patients with a ST-elevation acute coronary syndrome do not receive reperfusion therapy. In order to contribute to a better understanding of the clinical decision making process, we analyzed which factors are associated with the application of reperfusion therapy. Methods: From the Euro Heart Survey of Acute Coronary Syndromes I, 4,260 patients with ST-elevation acute coronary syndrome were selected for the current analysis, of which 1,539 (36%) patients received fibrinolysis and 904 (21%) primary percutaneous coronary intervention (PCI). The analysis contained 32 variables on demographics, medical history, admission parameters and reperfusion therapy. Results: A short pre-hospital delay, arrival in a hospital with PCI facilities, severe ST-elevation, and participation in a clinical trial were the strongest predictors for receiving reperfusion therapy. Primary PCI was more likely to be performed than fibrinolysis in patients with a long pre-hospital delay, arriving in a hospital with PCI facilities, not participating in a clinical trial, and with at least one previous PCI. Conclusion: Hospital facilities and culture, pre-hospital delay and infarction size play a major role in management decisions regarding reperfusion therapy in ST-elevation acute coronary syndrome. This analysis indicates which factors require special attention when implementing and reviewing the reperfusion guidelines. Copyright

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Keywords Acute coronary syndromes, Acute myocardial infarction, Percutaneous coronary intervention, Percutaneous transluminal coronary angioplasty, Reperfusion, Thrombolysis, Thrombolytic therapy, Treatment
Persistent URL dx.doi.org/10.1159/000092768, hdl.handle.net/1765/62288
Journal Cardiology: international journal of cardiovascular medicine, surgery and pathology
Citation
Nieuwlaat, R, Lenzen, M.J, Crijns, H.J, Prins, M.H, Scholte op Reimer, W.J.M, Battler, A, … Boersma, H. (2006). Which factors are associated with the application of reperfusion therapy in ST-elevation acute coronary syndromes? Lessons from the Euro Heart Survey on Acute Coronary Syndromes I. Cardiology: international journal of cardiovascular medicine, surgery and pathology, 106(3), 137–146. doi:10.1159/000092768