The development of door-to-angiography time in the last 14 years for patients with acute ST-elevation myocardial infarction treated with primary coronary intervention: Determinants and outcome. Results from the MITRAplus and OPTAMI registry.

Aim Of The Study: To examine the development of door-to-angiography time (DTA) and to evaluate the impact of door-to-angiography time in patients with ST-elevation myocardial infarction (STEMI) on hospital and one-year mortality.

Methods And Results: From 1994 to 2008, 5078 patients (pts) and known DTA with acute ST-elevation myocardial infarction were enrolled into the MITRAplus and OPTAMI registry in Germany. Our data showed a reduction of the door-to- angiography time from 80 min to 64 min in the last 14 years (P < 0.

Primary percutaneous coronary intervention and thrombolysis improve survival in patients with ST-elevation myocardial infarction and pre-hospital resuscitation.

Background: Patients with ST-elevation myocardial infarction (STEMI) surviving pre-hospital resuscitation represent a selected subgroup of patients with a very high adverse event rate. Only few data on the outcome of primary percutaneous coronary intervention (primary PCI) and thrombolysis in such patients are available.

Methods: We analysed the Maximal Individual Therapy of Acute Myocardial Infarction (MITRA) Plus registry.

Gender differences in patients with acute ST-elevation myocardial infarction complicated by cardiogenic shock.

Introduction: The aim of our analysis is to assess gender differences in baseline characteristics, acute therapies, and clinical outcome in patients with acute ST-elevation myocardial infarction (STEMI) complicated by cardiogenic shock.

Methods: The Maximal Individual Therapy of Acute Myocardial Infarction PLUS registry (MITRA PLUS) is a German prospective, multicenter, observational data pool of current treatment of STEMI.

Results: STEMI was more often (P < 0.

Clinical benefit of early reperfusion therapy in patients with ST-elevation myocardial infarction usually excluded from randomized clinical trials (results from the Maximal Individual Therapy in Acute Myocardial Infarction Plus [MITRA Plus] registry).

Randomized clinical trials (RCTs) usually enroll selected patient populations that may not be representative for patients seen in everyday practice. Therefore, concerns have been raised regarding their external validity. For the present study we evaluated the MITRA Plus registry and included 20,175 patients with ST-elevation myocardial infarction.

Reperfusion therapy for acute ST-elevation and non ST-elevation myocardial infarction: what can be achieved in daily clinical practice in unselected patients at an interventional center?

Background: In the year 2000 a new definition of acute myocardial infarction (AMI) was introduced, now differentiating ST segment elevation AMI (STEMI) from non-ST segment elevation AMI (NSTEMI). The characterization of AMI patients according to this definition is still incomplete.

Methods And Results: 888 consecutive AMI patients at a single interventional center were included: 493 (55.

Angioplasty within 24 h after thrombolysis in patients with acute ST-elevation myocardial infarction: current use, predictors and outcome. Results of the MITRA plus registry.

Background: Percutaneous coronary intervention (PCI) early after thrombolysis (early PCI) in patients with ST-elevation myocardial infarction (STEMI) is currently advised by clinical guidelines, but little is known about its use in clinical practice.

Methods: We analysed the MITRA (Maximal Individual Therapy of Acute Myocardial Infarction) plus registry.

Results: Out of a total of 34276 patients with STEMI, 10600 (30.

Incidence and clinical impact of right bundle branch block in patients with acute myocardial infarction: ST elevation myocardial infarction versus non-ST elevation myocardial infarction.

Background: Both left bundle branch block and right bundle branch block (RBBB) have been associated with increased inhospital and long-term mortality in patients with acute ST elevation myocardial infarction (STEMI). However, the prognostic role of RBBB in acute non-ST elevation myocardial infarction (NSTEMI) is not well known. Therefore, the aim of the study was to evaluate the incidence and clinical impact of RBBB in patients with NSTEMI compared to patients with STEMI.

Prehospital cardiac arrest: a marker for higher mortality in patients with acute myocardial infarction and moderately reduced left ventricular function: results from the MITRA plus registry.

Background: According to the current guidelines for acute myocardial infarction, ventricular fibrillation during the acute phase of myocardial infarction is no indication for specific treatment like ICD implantation. Primary objective of our study was to evaluate the prognostic significance of cardiac arrest within the acute phase of myocardial infarction in patients with moderately reduced left ventricular function.

Methods And Results: From 1994 until 2004, we included 7111 patients with acute STEMI and an LVEF >30% from the MITRA plus registry who were discharged alive from hospital and had a complete follow up.

Impact of the body mass index on occurrence and outcome of acute ST-elevation myocardial infarction.

Obesity is a traditional risk factor for the development of cardiovascular disease. However, recent studies have described a better outcome of obese patients in the clinical course of acute coronary syndromes.We investigated the impact of the body mass index (BMI) on occurrence and outcome of acute ST-elevation myocardial infarction (STEMI).

Prognostic impact of acute beta-blocker therapy on top of aspirin and angiotensin-converting enzyme inhibitor therapy in consecutive patients with ST-elevation acute myocardial infarction.

The prognostic effect of beta-blocker treatment on ST-elevation acute myocardial infarction (STEMI) is controversially discussed in the era of reperfusion therapy. From the German multicenter registry Maximal Individual Therapy of Acute Myocardial Infarction PLUS (MITRA PLUS), 17,809 consecutive patients with STEMI treated with a guideline-recommended therapy with aspirin and an angiotensin-converting enzyme inhibitor were investigated; the prognostic effect of additional acute beta-blocker treatment was analyzed. Patients with cardiogenic shock were excluded.

Actual clinical practice of exercise testing in consecutive patients after non-ST-elevation myocardial infarction: results of the acute coronary syndromes registry.

Background: Exercise testing has been advocated for risk stratification and determination of therapeutic strategies after acute myocardial infarction. Frequency and therapeutic impact of exercise testing after non-ST-elevation myocardial infarction (NSTEMI) in actual clinical practice, however, is not known.

Methods And Results: From the German acute coronary syndrome (ACOS) registry patients with acute NSTEMI (n = 5281) were evaluated: 20.

Too little aspirin for secondary prevention after acute myocardial infarction in patients at high risk for cardiovascular events: Results from the MITRA study.

Background: A meta-analysis of randomized trials has shown a significant reduction of mortality rate in patients receiving aspirin for secondary prevention after acute myocardial infarction (AMI). However, a significant number of patients do not receive aspirin after AMI. Little is known about why aspirin is withheld or the long-term outcome of these patients today.

Different treatments and outcomes of consecutive patients with non-ST-elevation myocardial infarction depending on initial electrocardiographic changes (results of the Acute Coronary Syndromes [ACOS] Registry).

Of 6,302 consecutive patients with acute non-ST-elevation myocardial infarction, 42.8% presented with ST depression, 31.9% showed no significant electrocardiographic changes, and 25.

Comparison of clinical benefits of clopidogrel therapy in patients with acute coronary syndromes taking atorvastatin versus other statin therapies.

In clinical practice, we found no significant difference between atorvastatin therapy or other statin therapies in the clinical outcomes of patients with acute coronary syndromes receiving clopidogrel therapy. In patients receiving atorvastatin therapy, clopidogrel therapy was associated with a significant decrease in mortality and stroke during univariate analysis and a moderate trend of reduced mortality and stroke without statistical significance in the multivariate analysis.

Impact of ramipril versus other angiotensin-converting enzyme inhibitors on outcome of unselected patients with ST-elevation acute myocardial infarction.

We examined the impact of treatment with ramipril versus other angiotensin-converting enzyme (ACE) inhibitors on clinical outcome in unselected patients of the prospective multicenter registry Maximal Individual Therapy of Acute Myocardial Infarction PLUS registry (MITRA PLUS). Of 14,608 consecutive patients with ST-elevation acute myocardial infarction, 4.7% received acute therapy with ramipril, 39.