Reperfusion therapy in the acute management of XXXX in Australia: findings from the ACACIA registry.

@entity1 @entity6 @entity714 @entity4 @entity1167 @entity583
OBJECTIVE: To describe the contemporary management and outcomes of @entity1 presenting with @entity583 ( @entity583 ) in Australia. DESIGN, @entity1 AND SETTING: Observational analysis of data for @entity1 who presented with suspected @entity583 and enrolled in the Australian Acute Coronary Syndrome Prospective Audit from 1 November 2005 to 31 July 2007. MAIN OUTCOME MEASURES: Factors associated with use of reperfusion therapy and timely use of reperfusion therapy, and the effects of reperfusion on mortality. RESULTS: In total, 755 @entity1 had suspected @entity583 . Median time to presentation was 105 minutes (IQR, 60-235 minutes). Reperfusion therapy was used in 66.9% of @entity1 (505/755), and timely reperfusion therapy in 23.1% (174/755). Thombolysis was administered in 39.2% of those who received reperfusion therapy (198/505), while 60.8% (307/505) received primary percutaneous intervention. @entity1167 (OR, 2.83; P = 0.001) and treatment under the auspices of a cardiology unit (OR, 2.14; P = 0.02) were associated with use of reperfusion therapy. A normal electrocardiogram on presentation (OR, 0.42; P = 0.01), @entity714 (OR, 0.18; P = 0.001), @entity4 (OR, 0.34; P < 0.01), history of @entity6 (OR, 0.54; P < 0.01), and previous lesion on angiogram of > 50% (OR, 0.51; P = 0.001) were associated with not using reperfusion. In hospital mortality was 4.0% (30/755), mortality at 30 days was 4.8% (36/755), and mortality at 1 year was 7.8% (59/755). Receiving reperfusion therapy of any kind was associated with decreased 12-month mortality (hazard ratio [HR], 0.44; 95% CI, 0.25-0.78; P < 0.01). Timely reperfusion was associated with a reduction in mortality of 78% (HR, 0.22; P = 0.04). There were no significant differences in early and late mortality in rural @entity1 compared with metropolitan @entity1 (P = 0.66). CONCLUSION: Timely reperfusion, not the modality of reperfusion, was associated with significant outcome benefits. Australian use of timely or any reperfusion remains poor and incomplete.
