232 Type of Reperfusion Therapy and Impact on Long-Term Survival in Patients with St-elevation Myocardial Infarction: Insight from the AMI-Québec Study

In meta-analyses of randomized clinical trials, PCI has been shown to improve survival over fibrinolytic therapy (FT) in patients with ST-elevation myocardial infarction (STEMI). Because of logistic reasons, FT remains the preferred reperfusion therapy (RT) in a significant number of patients with STEMI. We sought to determine long-term survival in un-selected patients with STEMI in the “real-life” setting. We hypothesized that patients undergoing primary PCI will have better 5-year survival than patients treated with FT or no RT. We completed a retrospective observational study of all patients with STEMI admitted at 17 Québec hospitals (Canada) in 2003. We obtained five-year survival data by linkage with the provincial administrative databases. Of 1,229 patients with complete information, 475 patients (38.6%) underwent primary PCI, 650 patients (52.9%) received FT and 104 patients (8.5%) did not receive any RT. Patients who did not receive RT were older (72.4 vs 60.9 years, P= 0.005) and had higher mean GRACE score compared to patients who received primary PCI or FT (173 vs 142 vs 138, respectively; P= 0.002). Patients who received RT had improved 5-year survival compared to patients who did not receive RT (Figure 1). RT was independently associated with reduction in long-term total mortality (HR 0.53, 95% CI[0.36-0.80]; P= 0.002). There was no significant difference in 5-year adjusted total mortality with primary PCI compared to FT(HR 1.20, 95% CI[0.82-1.76]; P = 0.34). Herein, we report survival data in a cohort of unselected STEMI patients with the longest follow-up period published to date. These results emphasize the importance of RT in patients with STEMI. In the present study, ‘real-life’ STEMI patients treated with FT had similar long-term survival compared to patients undergoing primary PCI. These findings support the complementary role of FT in the treatment of STEMI patients without timely access to primary PCI.