PMID- 30006115
OWN - NLM
STAT- MEDLINE
DCOM- 20191127
LR  - 20191127
IS  - 1444-2892 (Electronic)
IS  - 1443-9506 (Linking)
VI  - 28
IP  - 7
DP  - 2019 Jul
TI  - ST-Elevation Acute Myocardial Infarction in Australia-Temporal Trends in Patient 
      Management and Outcomes 1999-2016.
PG  - 1000-1008
LID - S1443-9506(18)30697-8 [pii]
LID - 10.1016/j.hlc.2018.05.191 [doi]
AB  - BACKGROUND: Increased access to reperfusion for ST elevation myocardial 
      infarction (STEMI) has contributed to reduced mortality internationally. We 
      describe temporal trends in pre-hospital care, in-hospital management and 
      outcomes of the STEMI population in Australia. METHODS: Temporal trends with 
      multiple regression analysis on the management and outcomes of STEMI patients 
      enrolled across 46 Australian hospitals in the Australian cohort of the Global 
      Registry of Acute Coronary Events (GRACE) and the Cooperative National Registry 
      of Acute Coronary Care Guideline Adherence and Clinical Events (CONCORDANCE) 
      between February 1999 and August 2016. RESULTS: 4,110 patients were treated for 
      STEMI, mean age 62.5+/-13.7years (SD). The median door-to-balloon time of primary 
      percutaneous coronary intervention (PPCI) decreased by 11minutes (p<0.01) 
      although there was no increase in rates of PPCI (p=0.35). Access to non-primary 
      PCI increased by 39% (p<0.01), provisioning of fibrinolysis decreased by 13% 
      (p<0.01) and the median door-to-needle time of 35minutes remained unchanged 
      (p=0.09). Prescription of medical therapies in-hospital remained high, and at 
      discharge there was an increase in prescription of statins (p<0.01); aspirin 
      including antiplatelets (p<0.01), beta blockers (p=0.023) and ACE/ARB (p=0.02). 
      The occurrence of any in-hospital adverse clinical events declined by 78% 
      (p<0.01) albeit, there was no reduction in mortality in-hospital (p=0.84) or 
      within 6 months (p=0.81). CONCLUSIONS: Over time, there has been increased access 
      to non-primary PCI; shorter door-to-balloon times for PPCI; less adverse events 
      in-hospital and fewer readmissions for unplanned revascularisation without the 
      realisation of reduced mortality in-hospital or at 6 months. TRIAL REGISTRATION: 
      CONCORDANCE Registry ACTRN: 12614000887673.
CI  - Copyright (c) 2018 Australian and New Zealand Society of Cardiac and Thoracic 
      Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). 
      All rights reserved.
FAU - Aliprandi-Costa, Bernadette
AU  - Aliprandi-Costa B
AD  - The University of Sydney, Faculty of Medicine, Sydney, NSW, Australia. Electronic 
      address: bernadette.aliprandicosta@sydney.edu.au.
FAU - Morgan, Lucy
AU  - Morgan L
AD  - The University of Sydney, Concord Clinical School, Sydney, NSW, Australia.
FAU - Snell, Lan-Chi
AU  - Snell LC
AD  - UTS Business School, Sydney, NSW, Australia.
FAU - D Souza, Mario
AU  - D Souza M
AD  - Sydney Local Health District, Sydney, NSW, Australia.
FAU - Kritharides, Leonard
AU  - Kritharides L
AD  - Cardiology Department Concord Hospital, Sydney, NSW, Australia.
FAU - French, John
AU  - French J
AD  - Cardiology Department, Liverpool Hospital, Sydney, NSW, Australia.
FAU - Brieger, David
AU  - Brieger D
AD  - Cardiology Department Concord Hospital, Sydney, NSW, Australia.
FAU - Ranasinghe, Isuru
AU  - Ranasinghe I
AD  - Discipline of Medicine, University of Adelaide, Queen Elizabeth Hospital, 
      Adelaide, SA, Australia.
LA  - eng
PT  - Clinical Trial
PT  - Journal Article
PT  - Multicenter Study
DEP - 20180611
PL  - Australia
TA  - Heart Lung Circ
JT  - Heart, lung & circulation
JID - 100963739
RN  - 0 (Hydroxymethylglutaryl-CoA Reductase Inhibitors)
RN  - 0 (Platelet Aggregation Inhibitors)
RN  - R16CO5Y76E (Aspirin)
SB  - IM
MH  - Aged
MH  - *Angioplasty, Balloon, Coronary
MH  - Aspirin/*administration & dosage
MH  - Australia/epidemiology
MH  - Female
MH  - *Hospital Mortality
MH  - Humans
MH  - Hydroxymethylglutaryl-CoA Reductase Inhibitors/*administration & dosage
MH  - Male
MH  - Middle Aged
MH  - Platelet Aggregation Inhibitors/*administration & dosage
MH  - *Registries
MH  - *ST Elevation Myocardial Infarction/mortality/therapy
MH  - Time Factors
OTO - NOTNLM
OT  - Acute coronary syndromes
OT  - Clinical registry
OT  - Quality outcomes
OT  - ST-elevation myocardial infarction
EDAT- 2018/07/15 06:00
MHDA- 2019/11/28 06:00
CRDT- 2018/07/15 06:00
PHST- 2017/11/01 00:00 [received]
PHST- 2018/04/12 00:00 [revised]
PHST- 2018/05/23 00:00 [accepted]
PHST- 2018/07/15 06:00 [pubmed]
PHST- 2019/11/28 06:00 [medline]
PHST- 2018/07/15 06:00 [entrez]
AID - S1443-9506(18)30697-8 [pii]
AID - 10.1016/j.hlc.2018.05.191 [doi]
PST - ppublish
SO  - Heart Lung Circ. 2019 Jul;28(7):1000-1008. doi: 10.1016/j.hlc.2018.05.191. Epub 
      2018 Jun 11.