The impact of pre-hospital thrombolytic treatment on re-infarction rates: analysis of the Myocardial Infarction National Audit Project (MINAP)

TY - JOUR

T1 - The impact of pre-hospital thrombolytic treatment on re-infarction rates

T2 - analysis of the Myocardial Infarction National Audit Project (MINAP)

AU - Horne, S

AU - Weston, C

AU - Quinn, T

AU - Hicks, A

AU - Walker, L

AU - Chen, R

AU - Birkhead, J

PY - 2009/4

Y1 - 2009/4

N2 - Objective: To examine the frequency and determinants of re-infarction after thrombolytic treatment of ST-elevation myocardial infarction (STEMI). Design: Observational study of national registry. Setting: Emergency ambulance services and admitting hospitals in England and Wales. Patients: 35 356 patients with STEMI given thrombolytic treatment in 2005–6. Main outcome measures: Re-infarction during hospital admission. Results: For 22 391 patients (63.3%) the presence or absence of re-infarction was recorded, and 1460 (6.5%) had re-infarction. Re-infarction rates with in-hospital treatment were similar for reteplase (6.5%) and tenecteplase (6.4%). When the interval from pre-hospital treatment to hospital arrival was greater than 30 minutes re-infarction rates were 12.5% for reteplase, and 11.4% for tenecteplase. Overall, re-infarction rates were higher after pre-hospital treatment with tenecteplase than reteplase (9.6% vs 6.6%, p = 0.005). After multivariate analysis independent predictors of re-infarction for tenecteplase were pre-hospital treatment, OR 1.44 (95% CI 1.21 to 1.71, p<0.001) and weight in the highest quartile compared to the lowest, OR 1.66 (95% CI 1.19 to 2.31, p = 0.003). For reteplase neither factor predicted re-infarction. Bleeding was less common with pre-hospital treatment—overall 1.8% against 3.1%; intracerebral bleeding 0.4% against 0.7%. Conclusion: Pre-hospital treatment with tenecteplase was associated with higher re-infarction rates. Longer intervals from pre-hospital treatment to arrival in hospital were associated with high re-infarction rates for both tenecteplase and reteplase. Differences in the use of adjunctive anti-thrombotic therapy in the two treatment environments may underlie the differences in re-infarction rates and bleeding complications observed between pre-hospital and in-hospital thrombolytic treatment.

AB - Objective: To examine the frequency and determinants of re-infarction after thrombolytic treatment of ST-elevation myocardial infarction (STEMI). Design: Observational study of national registry. Setting: Emergency ambulance services and admitting hospitals in England and Wales. Patients: 35 356 patients with STEMI given thrombolytic treatment in 2005–6. Main outcome measures: Re-infarction during hospital admission. Results: For 22 391 patients (63.3%) the presence or absence of re-infarction was recorded, and 1460 (6.5%) had re-infarction. Re-infarction rates with in-hospital treatment were similar for reteplase (6.5%) and tenecteplase (6.4%). When the interval from pre-hospital treatment to hospital arrival was greater than 30 minutes re-infarction rates were 12.5% for reteplase, and 11.4% for tenecteplase. Overall, re-infarction rates were higher after pre-hospital treatment with tenecteplase than reteplase (9.6% vs 6.6%, p = 0.005). After multivariate analysis independent predictors of re-infarction for tenecteplase were pre-hospital treatment, OR 1.44 (95% CI 1.21 to 1.71, p<0.001) and weight in the highest quartile compared to the lowest, OR 1.66 (95% CI 1.19 to 2.31, p = 0.003). For reteplase neither factor predicted re-infarction. Bleeding was less common with pre-hospital treatment—overall 1.8% against 3.1%; intracerebral bleeding 0.4% against 0.7%. Conclusion: Pre-hospital treatment with tenecteplase was associated with higher re-infarction rates. Longer intervals from pre-hospital treatment to arrival in hospital were associated with high re-infarction rates for both tenecteplase and reteplase. Differences in the use of adjunctive anti-thrombotic therapy in the two treatment environments may underlie the differences in re-infarction rates and bleeding complications observed between pre-hospital and in-hospital thrombolytic treatment.

KW - Aged

KW - Body Weight

KW - Emergency Treatment

KW - Female

KW - Fibrinolytic Agents

KW - Hospital Mortality

KW - Hospitalization

KW - Humans

KW - Male

KW - Middle Aged

KW - Multivariate Analysis

KW - Myocardial Infarction

KW - Recombinant Proteins

KW - Recurrence

KW - Retrospective Studies

KW - Thrombolytic Therapy

KW - Tissue Plasminogen Activator

KW - Treatment Outcome

U2 - 10.1136/hrt.2007.126821

DO - 10.1136/hrt.2007.126821

M3 - Article

C2 - 17923462

SN - 1355-6037

VL - 95

SP - 559

EP - 563

JO - Heart

JF - Heart

IS - 7

ER -