The 60 Minutes Myocardial Infarction Project. Characteristics on admission and clinical outcome in patients with reinfarction compared to patients with a first infarction

Purpose The purpose of the study was to evaluate parameters that characterizepatients with myocardial reinfarction as compared to patientswith a first infarction in clinical practice, and possibly todetermine their clinical outcome. Methods The 60 Minutes Myocardial Infarction Project is a German multicentreprospective observational study in which 136 hospitals are participating.Fourteen thousand, nine hundred and eighty consecutive patientswith acute Q wave myocardial infarction were included from July1992 to September 1994. Results Out of these 14980 patients, there were 2854 (19%) with reinfarctionand 12126 (81%) with a first infarction. Patients with a reinfarctionarrived at the hospital 24min earlier than patients with a firstinfarction (pre-hospital delay 156 vs 180min;P<0·001);the door-to-needle time with reinfarction was longer (38 vs30min;P<0·001); however, patients with reinfarctionwere older (69 vs 66 years;P<0·001), had a lower rateof a diagnostic first ECG (54 vs 71%;P<0·001) andreceived thrombolytic therapy less frequently than patientswith a first infarction (46 vs 52%;P<0·001). A lownumber of patients received primary PTCA (n=205) since onlya few hospitals offered a primary PTCA service at the time thestudy was performed. In patients with reinfarction, there weremore reasons as to why thrombolytic therapy was not given (24vs 21%;P<0·001). Left bundle branch block occurredmore frequently in patients with reinfarction (15 vs 8%;P<0·001).The intra-hospital course in patients with reinfarction wasassociated with an increase of complications and intra-hospitaldeath (23 vs 15%;P<0·001). Conclusions Although reinfarction patients arrived earlier at hospital thanpatients with a first infarction, the former received thrombolytictherapy less frequently than the latter. Patients with reinfarctionwere older, more frequently had a non-diagnostic ECG on admissionand had a higher rate of contraindications against thrombolytictherapy.