International study highlights underuse of reperfusion therapy for heart-attack patients

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Up to a third of patients with a severe heart attack may not be receiving reperfusion therapy, despite the well-known benefits of this treatment strategy, conclude authors of an international study in this weeks issue of THE LANCET.

The benefits of reperfusion therapy- the use of fibrinolytic agents and/or coronary angioplasty to restore coronary artery bloodflow -for patients with acute coronary syndromes have been established, but there is variation in the type of reperfusion given and in decisions about which patients are eligible for such therapy. Kim Eagle from the University of Michigan Medical Center, USA, and colleagues assessed current practices in relation to reperfusion therapy in patients with a specific heart-attack profile called ST-segment-elevation myocardial infarction using data from the multinational, prospective Global Registry of Acute Coronary Events (GRACE). This registry includes data for patients with acute coronary syndromes from 94 hospitals in 14 countries.

The investigators assessed data of the first 9251 patients enrolled in GRACE; of these, 1763 presented within 12 hours of symptom onset with ST-segment-elevation myocardial infarction, 30% of whom did not receive reperfusion therapy. Elderly patients (75 years and older), those presenting without chest pain, and those with a history of diabetes, congestive heart failure, myocardial infarction, or coronary bypass surgery were less likely to receive reperfusion therapy. The rate of primary percutaneous coronary intervention was highest in the USA (17%) and lowest in Australia, New Zealand, and Canada (1%). The rate at sites with a catheterisation laboratory was 19%.

Kim Eagle comments: A substantial proportion of patients who are eligible for reperfusion therapy still do not receive this treatment.

Contact: Richard Lane

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