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ISCHAEMIC HEART DISEASE
To evaluate the outcome of different reperfusion strategies, the outcomes of 26 205 consecutive patients with ST-elevation MI (STEMI) from the RIKS-HIA (Register of Information and Knowledge about Swedish Heart Intensive Care Admissions) database were studied retrospectively. Overall 7084 patients underwent primary PCI, 3078 had pre-hospital thrombolysis (PHT) and 16 043 had in-hospital thrombolysis (IHT); all patients included in the analysis had received reperfusion therapy within 15 hours of symptom onset. The main outcome measures studied were mortality, reinfarction and readmissions. At 30 days, primary PCI was associated with a lower mortality than both IHT (4.9% v 11.4%) and PHT (4.9% v 7.6%), and this benefit was sustained at 1-year follow-up. PHT predicted a lower mortality rate than IHT at 30 days (hazard ratio (HR) 0.87) and at 1 year (HR 0.84), but beyond 2 hours’ treatment delay the observed mortality reductions with PHT tended to decrease while the benefits
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