Delay in presentation and reperfusion therapy in ST-segment elevation myocardial infarction: Gaps between practice and the guidelines

Background: It remains unclear if early use of intravenous (IV) beta-blockers (iBB) improves clinical outcomes patients with ST-segment elevation myocardial infarction (MI; STEMI), especially among those who received reperfusion therapy. Objective: To evaluate effect of early iBB use on clinical outcomes among patients with STEMI. Methods: A systematic review of randomized control trials in MEDLINE, EMBASE, CINAHL, and Cochrane databases comparing early use (administered within 12 hours of presentation) of iBB with standard medical therapy/placebo among patients who presented with STEMI. The effect of iBB was assessed by stratifying studies into pre-reperfusion and reperfusion trials and pooled treatment effects were estimated using relative risk with Mantel-Haenszel risk ratio, using a random-effects model Results: Twenty-one studies (N=74,801) were selected for final analysis. Clinical outcomes at 30 days and 1 year are summarized in table below. Conclusion: In the current reperfusion era, early use of iBB in patients with STEMI was associated with reduction in the risk of recurrent MI and ventricular tachyarrhythmias without any significant reduction in all-cause or CV mortality or increase in the risk of cardiogenic shock.

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Background and design of the ACCA–EAPCI registry on ST-segment elevation myocardial infarction of the European Society of Cardiology

European Heart Journal Acute Cardiovascular Care ◽

10.1177/2048872617745008 ◽

2018 ◽

Vol 8 (1) ◽

pp. 63-67 ◽

Cited By ~ 2

Author(s):

Uwe Zeymer ◽

Peter Ludman ◽

Nicolas Danchin ◽

Petr Kala ◽

Aldo P Maggioni ◽

...

Keyword(s):

Myocardial Infarction ◽

European Society ◽

Coronary Intervention ◽

Reperfusion Therapy ◽

Special Focus ◽

St Segment Elevation ◽

Segment Elevation Myocardial Infarction ◽

St Segment ◽

Esc Guidelines ◽

European Society Of Cardiology

Treatment of patients with acute ST-segment elevation myocardial infarction has improved over past decades, with reperfusion therapy being the cornerstone in the acute phase. Based on the results of large randomised trials the current ST-segment elevation myocardial infarction guidelines of the European Society of Cardiology (ESC) recommend acute treatments and secondary prevention therapies. However, there are large variations between ESC countries in the treatment of patients presenting with ST-segment elevation myocardial infarction. Therefore the ESC has initiated a prospective registry to evaluate the current treatments and outcomes of these patients with a special focus on adherence to the ESC guidelines and on differences between countries and regions. This paper describes the methodology and design of the ST-segment elevation myocardial infarction registry conducted in collaboration of the Acute Cardiac Care Association and the European Association of Percutaneous Coronary Intervention.

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