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The current treatment of ST segment elevation myocardial infarction (STEMI) is mechanical reperfusion by Primary Percutaneous Coronary Intervention (PPCI) or systemic thrombolysis. Several factors are related to non-reperfusion, with advanced age being particularly significant. At present, no study has examined the presentation and characteristics of the non-reperfused patient in Ireland. Further study is clearly needed in this area, especially as the older demographic of the population increases.
To define, understand and critically evaluate STEMI patients who do not receive reperfusion therapy.
The Coronary Heart Attack Ireland Register (CHAIR) was used to identify STEMI patients who did not receive reperfusion therapy between January 1st 2007 and December 31st 2011. A retrospective review of patient charts was performed at Cork University Hospital, Mercy University Hospital, South Infirmary Victoria University Hospital and Mallow General Hospital. The contribution of non-reperfusion to patient mortality was also examined in terms of 30-day mortality and 1-year mortality post STEMI.
77 cases were included. Results indicate that most were female (n=47, 61%) with a median age of 80.39 years. 54.5% (n=42) had a past medical history of coronary heart disease with hypertension being the main risk factor (n=43, 55.8%). 49% (n=38) were considered independent in terms of ADLs. Patient mortality at 30 days post STEMI was 55.8%. This increased to 61% at 1 year.
As the older demographic in our population increases, this patient cohort will become particularly significant. Mortality among these patients is high yet a significant number were considered independent in terms of ADLs. Prospective evaluation of this patient cohort needs to take place to monitor the effect of the introduction of the PPCI National Strategy in Ireland in 2012. Internationally, larger studies are needed to determine the role of social factors as predictors of non-reperfusion.