Which Factors Are Associated with the Application of Reperfusion Therapy in ST-Elevation Acute Coronary Syndromes?

Background/Aims: A large proportion of patients with a ST-elevation acute coronary syndrome do not receive reperfusion therapy. In order to contribute to a better understanding of the clinical decision making process, we analyzed which factors are associated with the application of reperfusion therapy. Methods: From the Euro Heart Survey of Acute Coronary Syndromes 1, 4,260 patients with ST-elevation acute coronary syndrome were selected for the current analysis, of which 1,539 (36%) patients received fibrinolysis and 904 (21%) primary percutaneous coronary intervention (PCl). The analysis contained 32 variables on demographics, medical history, admission parameters and reperfusion therapy. Results: A short pre-hospital delay, arrival in a hospital with PCl facilities, severe ST-elevation, and participation in a clinical trial were the strongest predictors for receiving reperfusion therapy. Primary PCl was more likely to be performed than fibrinolysis in patients with a long pre-hospital delay, arriving in a hospital with PCl facilities, not participating in a clinical trial, and with at least one previous PCl. Conclusion: Hospital facilities and culture, pre-hospital delay and infarction size play a major role in management decisions regarding reperfusion therapy in ST-elevation acute coronary syndrome. This analysis indicates which factors require special attention when implementing and reviewing the reperfusion guidelines. Copyright (c) 2006 S. Karger AG, Basel.