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A decade of improvement in the management of New Zealand ST-elevation myocardial infarction (STEMI) patients: results from the New Zealand Acute Coronary Syndrome (ACS) Audit Group national audits of 2002, 2007 and 2012.

Abstract To audit the management of ST-segment elevation myocardial infarction (STEMI) patients admitted to a New Zealand Hospital over three 14-day periods to review their number, characteristics, management and outcome changes over a decade.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title the new zealand medical journal
Publication Year Start




PMID- 28384143
OWN - NLM
STAT- In-Process
DA  - 20170406
LR  - 20170406
IS  - 1175-8716 (Electronic)
IS  - 0028-8446 (Linking)
VI  - 130
IP  - 1453
DP  - 2017 Apr 07
TI  - A decade of improvement in the management of New Zealand ST-elevation myocardial 
      infarction (STEMI) patients: results from the New Zealand Acute Coronary Syndrome
      (ACS) Audit Group national audits of 2002, 2007 and 2012.
PG  - 17-28
AB  - AIMS: To audit the management of ST-segment elevation myocardial infarction
      (STEMI) patients admitted to a New Zealand Hospital over three 14-day periods to 
      review their number, characteristics, management and outcome changes over a
      decade. METHODS: The acute coronary syndrome (ACS) audits were conducted over 14 
      days in May of 2002, 2007 and 2012 at New Zealand Hospitals admitting patients
      with a suspected or definite ACS. Longitudinal analyses of the STEMI subgroup are
      reported. RESULTS: From 2002 to 2012, the largest change in management was the
      proportion of patients undergoing reperfusion by primary PCI from 3% to 15% and
      41%; P<0.001, and the rates of second antiplatelet agent use in addition to
      aspirin from 14% to 62% and 98%; P<0.001. The use of proven secondary prevention 
      medications at discharge also increased during the decade. There were also
      significant increases in cardiac investigations for patients, especially
      echocardiograms (35%, 62% and 70%, P<0.001) and invasive coronary angiograms
      (31%, 58% and 87%, P<0.001). Notably even in 2012, one in four patients
      presenting with STEMI did not receive any reperfusion therapy. CONCLUSIONS:
      Substantial improvements have been seen in the management of STEMI patients in
      New Zealand over the last decade, in accordance with evidenced-based guideline
      recommendations. However, there appears to be considerable room to optimise
      management, particularly with the use of timely reperfusion therapy for more
      patients.
FAU - Elliott, John M
AU  - Elliott JM
AD  - Cardiologist, Christchurch Hospital, Christchurch.
FAU - Wang, Tom Kai Ming
AU  - Wang TK
AD  - Cardiology Registrar, Green Lane Cardiovascular Service, Auckland City Hospital, 
      Auckland.
FAU - Gamble, Greg D
AU  - Gamble GD
AD  - Statistician, University of Auckland, Auckland.
FAU - Williams, Michael Ja
AU  - Williams MJ
AD  - Cardiologist, Dunedin Hospital, Dunedin.
FAU - Matsis, Philip
AU  - Matsis P
AD  - Cardiologist, Wellington Hospital, Wellington.
FAU - Troughton, Richard
AU  - Troughton R
AD  - Cardiologist, Christchurch Hospital, Christchurch.
FAU - Hamer, Andrew
AU  - Hamer A
AD  - Cardiologist, Nelson Hospital, Nelson.
FAU - Devlin, Gerry
AU  - Devlin G
AD  - Cardiologist, Waikato Hospital, Hamilton.
FAU - Mann, Stewart
AU  - Mann S
AD  - Cardiologist, Wellington Hospital, Wellington.
FAU - Richards, Mark
AU  - Richards M
AD  - Cardiologist, Christchurch Hospital, Christchurch.
FAU - French, John K
AU  - French JK
AD  - Cardiologist, Liverpool Hospital, SW Sydney Clinical School (UNSW) Sydney,
      Australia.
FAU - White, Harvey D
AU  - White HD
AD  - Cardiologist, Green Lane Cardiovascular Service, Auckland City Hospital,
      Auckland.
FAU - Ellis, Chris J
AU  - Ellis CJ
AD  - Cardiologist, Green Lane Cardiovascular Service, Auckland City Hospital,
      Auckland. For the NZ Regional Cardiac Society ACS Audit Group.
LA  - eng
PT  - Journal Article
DEP - 20170407
PL  - New Zealand
TA  - N Z Med J
JT  - The New Zealand medical journal
JID - 0401067
COI - Dr Hamer reports affiliation with Capricor Inc and Amgen Inc outside the
      submitted work. A part of Dr Hamer's income was reimbursed to Nelson Marlborough 
      District Health Board by the Ministry of Health for New Zealand Cardiac Network
      responsibilities during the time that this research was performed; Dr White
      reports grants and non-financial support from GlaxoSmithKline during the conduct 
      of the study, grants from Sanofi Aventis, grants from Eli Lilly and Company,
      grants from National Institute of Health, grants from Merck Sharpe and Dohm,
      grants and personal fees from AstraZeneca, grants from Omthera Pharmaceuticals,
      grants from Pfizer New Zealand, grants from Intarcia Therapeutics Inc, grants
      from Elsai Inc and grants from DalGen Products and Services outside the submitted
      work.
EDAT- 2017/04/07 06:00
MHDA- 2017/04/07 06:00
CRDT- 2017/04/07 06:00
PST - epublish
SO  - N Z Med J. 2017 Apr 7;130(1453):17-28.

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