BACKGROUND: Percutaneous coronary intervention (PCI) performed within 12 h from symptom onset enables complete blood flow restoration in infarct-related artery in 90% of patients. Nevertheless, even with complete restoration of epicardial blood flow in culprit vessel (postprocedural Thrombolysis in Myocardial Infarction (TIMI) flow grade 3), myocardial perfusion at tissue level may be insufficient. We hypothesized that the outcome of patients with STEMI/bundle branch block (BBB)-myocardial infarction and post-PCI TIMI 3 flow is related to the time to reperfusion. METHODS: Observational study based on a retrospective analysis of population of 635 consecutive patients with STEMI/BBB-MI and post-PCI TIMI 3 flow from January 2009 to December 2011 (mean age 63 years, 69.6% males). Mortality of patients was evaluated in relation to the time from symptom onset to reperfusion. RESULTS: A total of 83 patients (13.07%) with postprocedural TIMI 3 flow after PCI had died at 1-year follow-up. Median TD in patients who survived was 3.92 h (iqr 5.43), in patients who died 6.0 h (iqr 11.42), P = 0.004. Multiple logistic regression analysis identified time delay ≥ 9 h as significantly related to 1-year mortality of patients with STEMI/BBB-MI and post-PCI TIMI 3 flow (OR 1.958, P = 0.026). Other significant variables associated with mortality in multivariate regression analysis were: left ventricle ejection fraction < 30% (P = 0.006), age > 65 years (P < 0.001), Killip class >2 (P <0.001), female gender (P = 0.019), and creatinine clearance < 30 mL/min (P < 0.001). CONCLUSION: Time delay to reperfusion is significantly related to 1-year mortality of patients with STEMI/BBB-MI and complete restoration of epicardial blood flow in culprit vessel after PCI.

• MeSH
• blokáda Tawarova raménka mortalita   chirurgie   MeSH
• čas zasáhnout při rozvinutí nemoci MeSH
• infarkt myokardu mortalita   chirurgie   MeSH
• Kaplanův-Meierův odhad MeSH
• koronární angioplastika mortalita   MeSH
• koronární stenóza mortalita   chirurgie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mikrocirkulace fyziologie   MeSH
• pooperační komplikace mortalita   MeSH
• reperfuze myokardu mortalita   MeSH
• retrospektivní studie MeSH
• senioři MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• pozorovací studie MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Česká republika epidemiologie   MeSH

AIMS: Primary percutaneous coronary intervention (PPCI) is the preferred reperfusion therapy in ST-elevation myocardial infarction (STEMI). We conducted this study to evaluate the contemporary status on the use and type of reperfusion therapy in patients admitted with STEMI in the European Society of Cardiology (ESC) member countries. METHODS AND RESULTS: A cross-sectional descriptive study based on aggregated country-level data on the use of reperfusion therapy in patients admitted with STEMI during 2010 or 2011. Thirty-seven ESC countries were able to provide data from existing national or regional registries. In countries where no such registries exist, data were based on best expert estimates. Data were collected on the use of STEMI reperfusion treatment and mortality, the numbers of cardiologists, and the availability of PPCI facilities in each country. Our survey provides a brief data summary of the degree of variation in reperfusion therapy across Europe. The number of PPCI procedures varied between countries, ranging from 23 to 884 per million inhabitants. Primary percutaneous coronary intervention and thrombolysis were the dominant reperfusion strategy in 33 and 4 countries, respectively. The mean population served by a single PPCI centre with a 24-h service 7 days a week ranged from 31 300 inhabitants per centre to 6 533 000 inhabitants per centre. Twenty-seven of the total 37 countries participated in a former survey from 2007, and major increases in PPCI utilization were observed in 13 of these countries. CONCLUSION: Large variations in reperfusion treatment are still present across Europe. Countries in Eastern and Southern Europe reported that a substantial number of STEMI patients are not receiving any reperfusion therapy. Implementation of the best reperfusion therapy as recommended in the guidelines should be encouraged.

• MeSH
• dospělí MeSH
• infarkt myokardu mortalita   terapie   MeSH
• kardiologie pracovní síly   MeSH
• koronární angioplastika mortalita   využití   MeSH
• koronární jednotky zásobování a distribuce   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mortalita v nemocnicích MeSH
• průřezové studie MeSH
• registrace MeSH
• reperfuze myokardu mortalita   využití   MeSH
• senioři MeSH
• trombolytická terapie mortalita   využití   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Evropa MeSH

Cíl: Posoudit užitečnost primární reperfuzní léčby u pacientů v akutní fázi infarktu myokardu s elevací ST-segmentu (STEMI) v České republice. Metoda: Do studie bylo zařazeno celkem 744 po sobě jdoucích pacientů se STEMI v letech 2003-2006. Byly shromážděny i jejich demografické údaje a informace o reperfuzní strategii. Hodnoceným klinickým parametrem byla nemocniční mortalita. Výsledky: Průměrný věk pacientů se STEMI byl 66,9 ± 12,6 let. V převážné většině se jednalo o muže (62,4 %). Primární reperfuzní léčba byla provedena celkem u 68,6 % pacientů se STEMI, 97,0 % jich bylo indikováno k provedení primární perkutární koronární intervenci (PPCI) a 3,6 % jich bylo léčeno fibrinolýzou. U žen a starších nemocných existovala menší pravděpodobnost, že u nich bude provedena reperfuzní léčba. Nemocniční mortalita u všech pacientů se STEMI dosáhla 11,3 %; z toho 3,5 % ve skupině s reperfuzí a 25,7 % ve skupině bez reperfuze (p < 0,001). Po korekci na věk zůstal účinek reperfuzní léčby statisticky významný. Závěry: V podskupině nemocných, u nichž byla provedena reperfuzní léčba (PPCI nebo fibrinolytická terapie) byla nemocniční mortalita statisticky významně snížena. PPCI je absolutně převládající formou reperfuzní strategie v České republice.

Aim: To assess utilization of primary reperfusion therapy in patients with acute phase of ST-segment elevation myocardial infarction (STEMI) in the Czech Republic. Methods: A total of 744 consecutive patients with STEMI from years 2003-2006 were included in the study. Also, data on their demographics and reperfusion strategy were collected. An assessed clinical outcome was in-hospital mortality. Results: The mean age of STEMI patients was 66.9 ± 12.6 years. The vast majority were men (62.4%). A total of 68.6% STEMI patients received primary reperfusion treatment, 97.0% of them were referred for PPCI and 3.6% were treated with fibrinolytic therapy. Women and elderly patients were less likely to receive reperfusion therapy. The in-hospital mortality was 11.3% for all STEMI patients; 3.5% and 25.7% in the reperfused and non-reperfused groups, (p < 0.001). When adjusting for age, the effect of reperfusion therapy remained significant. Conclusions: In-hospital mortality was significantly reduced in a subgroup of patients who underwent primary reperfusion treatment (PPCI or fibrinolytic therapy). The PPCI represents the entirely prevalent form of reperfusion strategy in the Czech Republic. Key words:

• MeSH
• balónková koronární angioplastika metody   mortalita   využití   MeSH
• chorobopisy statistika a číselné údaje   MeSH
• fibrinolýza fyziologie   účinky léků   MeSH
• financování organizované využití   MeSH
• infarkt myokardu diagnóza   mortalita   terapie   MeSH
• interpretace statistických dat MeSH
• reperfuze myokardu metody   mortalita   využití   MeSH
• retrospektivní studie MeSH
• sběr dat metody   využití   MeSH

BACKGROUND: Data comparing survival outcomes for women versus men transported for pPCI were absent. OBJECTIVES: To assess the impact of gender on 30-day mortality of patients with STEMI transported for pPCI. METHODS: The data from the PRAGUE-1 and PRAGUE-2 trials were analysed. Studies compared thrombolysis in the community hospital and pPCI after transportation to cardiocentre. A group of 520 patients treated with thrombolysis, and 530 transported for pPCI, were analysed. RESULTS: Women were older, with a higher risk profile. They had longer ischaemia time. Mortality of patients treated with TL was significantly higher in women than in men (15% vs 9%, p = 0.043). There was no significant gender difference in mortality in the PCI group (8.2% of women vs 6.2% of men, p = 0.409). Mortality of women treated with on-site TL was nearly twice as high as mortality of women transported for pPCI (p = 0.043). After adjustment in a multivariate model the odds ratio for mortality in women was 0.74 (95% CI 0.26 to 2.05; p = 0.556). CONCLUSION: Long-distance transportation of women with STEMI from a community hospital to a tertiary PCI centre is a significantly more effective treatment strategy than on-site TL. Gender did not determine survival in patients transported for pPCI

• MeSH
• balónková koronární angioplastika metody   mortalita   MeSH
• epidemiologické metody MeSH
• financování organizované MeSH
• infarkt myokardu farmakoterapie   mortalita   terapie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• přemístění pacientů metody   MeSH
• randomizované kontrolované studie jako téma MeSH
• reperfuze myokardu metody   mortalita   MeSH
• senioři MeSH
• sexuální faktory MeSH
• srdeční katetrizace metody   mortalita   MeSH
• trombolytická terapie metody   mortalita   MeSH
• věkové rozložení MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH