1. Temporal trends and prognostic impact of reperfusion modalities in Tunisian patients presenting with ST-elevation myocardial infarction: A 20-year analysis.
- Author
-
Jomaa W, Chamtouri I, Amdouni N, Turki A, and Ben Hamda K
- Subjects
- Humans, Male, Tunisia epidemiology, Female, Middle Aged, Prognosis, Aged, Treatment Outcome, Time Factors, Retrospective Studies, ST Elevation Myocardial Infarction therapy, ST Elevation Myocardial Infarction mortality, ST Elevation Myocardial Infarction epidemiology, ST Elevation Myocardial Infarction diagnosis, ST Elevation Myocardial Infarction surgery, Percutaneous Coronary Intervention statistics & numerical data, Myocardial Reperfusion statistics & numerical data, Myocardial Reperfusion methods, Myocardial Reperfusion trends, Hospital Mortality trends, Registries statistics & numerical data
- Abstract
Introduction: With the advent of reperfusion therapies, management of patients presenting with ST-elevation myocardial infarction (STEMI) has witnessed significant changes during the last decades., Aim: We sought to analyze temporal trends in reperfusion modalities and their prognostic impact over a 20-year period in patients presenting with STEMI the Monastir region (Tunisia)., Methods: Patients from Monastir region presenting for STEMI were included in a 20-year (1998-2017) single center registry. Reperfusion modalities, early and long-term outcomes were studied according to five four-year periods., Results: Out of 1734 patients with STEMI, 1370 (79%) were male and mean age was 60.3 ± 12.7 years. From 1998 to 2017, primary percutaneous coronary intervention (PCI) use significantly increased from 12.5% to 48.3% while fibrinolysis use significantly decreased from 47.6% to 31.7% (p<0.001 for both). Reperfusion delays for either fibrinolysis or primary PCI significantly decreased during the study period. In-hospital mortality significantly decreased from 13.7% during Period 1 (1998-2001) to 5.4% during Period 5 (2014-2017), (p=0.03). Long-term mortality rate (mean follow-up 49.4 ± 30.7 months) significantly decreased from 25.3% to 13% (p<0.001). In multivariate analysis, age, female gender, anemia on-presentation, akinesia/dyskinesia of the infarcted area and use of plain old balloon angioplasty were independent predictors of death at long-term follow-up whereas primary PCI use and preinfaction angina were predictors of long-term survival., Conclusions: In this long-term follow-up study of Tunisian patients presenting for STEMI, reperfusion delays decreased concomitantly to an increase in primary PCI use. In-hospital and long-term mortality rates significantly decreased from 1998 to 2017.
- Published
- 2024
- Full Text
- View/download PDF