Copyright © 1998 by the European Society of Cardiology.
The 60 Minutes Myocardial Infarction Project. Characteristics on admission and clinical outcome in patients with reinfarction compared to patients with a first infarction
a Herzzentrum Ludwigshafen, Lugwigshafen, Germany
b Klinikum Nürnberg Süd, Nürnberg, Germany
accepted November 21, 1997
Purpose
The purpose of the study was to evaluate parameters that characterize patients with myocardial reinfarction as compared to patients with a first infarction in clinical practice, and possibly to determine their clinical outcome.
Methods
The 60 Minutes Myocardial Infarction Project is a German multicentre prospective observational study in which 136 hospitals are participating. Fourteen thousand, nine hundred and eighty consecutive patients with acute Q wave myocardial infarction were included from July 1992 to September 1994.
Results
Out of these 14980 patients, there were 2854 (19%) with reinfarction and 12126 (81%) with a first infarction. Patients with a reinfarction arrived at the hospital 24min earlier than patients with a first infarction (pre-hospital delay 156 vs 180min;P<0·001); the door-to-needle time with reinfarction was longer (38 vs 30min;P<0·001); however, patients with reinfarction were older (69 vs 66 years;P<0·001), had a lower rate of a diagnostic first ECG (54 vs 71%;P<0·001) and received thrombolytic therapy less frequently than patients with a first infarction (46 vs 52%;P<0·001). A low number of patients received primary PTCA (n=205) since only a few hospitals offered a primary PTCA service at the time the study was performed. In patients with reinfarction, there were more reasons as to why thrombolytic therapy was not given (24 vs 21%;P<0·001). Left bundle branch block occurred more frequently in patients with reinfarction (15 vs 8%;P<0·001). The intra-hospital course in patients with reinfarction was associated with an increase of complications and intra-hospital death (23 vs 15%;P<0·001).
Conclusions
Although reinfarction patients arrived earlier at hospital than patients with a first infarction, the former received thrombolytic therapy less frequently than the latter. Patients with reinfarction were older, more frequently had a non-diagnostic ECG on admission and had a higher rate of contraindications against thrombolytic therapy.
Key Words: acute myocardial infarction • reinfarction • thrombolysis • pre-hospital delay times
Presented at the XIXthCongress of the European Society of Cardiology.
Supported in part by Dr Karl Thomae GmbH Biberach, Germany and Behringwerke AG, Liederbach, Germany.
f2 Correspondence: Stefan Wagner, MD, Herzzentrum Ludwigshafen, Department of Cardiology, Bremserstr. 79, D-67063 Ludwigshafen, Germany.