1
|
Yang H, Luo L, Huang Z, Song Y, Cao J, Weng X, Zhang F, Zhou X, Qian J, Ge J, Zheng Y. Association between patient and system delays and in-hospital mortality in primary PCI for STEMI: Findings from a large, nationwide inpatients sample. Am J Med 2024:S0002-9343(24)00550-3. [PMID: 39233017 DOI: 10.1016/j.amjmed.2024.08.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Revised: 08/13/2024] [Accepted: 08/17/2024] [Indexed: 09/06/2024]
Abstract
PURPOSE System delay is associated with mortality in patients undergoing primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI). However, the influence of patient delay has been relatively overlooked. We aimed to evaluate the influence of patient and system delays on STEMI patients undergoing primary PCI in China. METHODS STEMI patients registered at the Nationwide Chinese Cardiovascular Association Database-Chest Pain Center from January 2017 to September 2021 were screened. The exposures were total ischemic time (TIT), system delay and patient delay. The primary outcome was in-hospital mortality. RESULTS Among 458,260 patients from 2,529 centers, median TIT, system delay and patient delay were 4.1, 1.5 and 2.1 hours, respectively. The adjusted odds ratio of in-hospital mortality increased by 2.2% (odds ratio [OR], 1.022, 95% confidence interval [CI], 1.017-1.027), 2.3% (1.023, 1.006-1.040) and 2.2% (1.022, 1.017-1.027) for every one-hour increase in TIT, system delay and patient delay, respectively. CONCLUSIONS Patient delay demonstrated a comparable impact to system delay on in-hospital mortality among STEMI patients undergoing primary PCI. Widespread primary PCI-capable center, improved awareness about myocardial infarction and regional transfer system are essential to shorten patient delay.
Collapse
Affiliation(s)
- Hongbo Yang
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China; National Clinical Research Center for Interventional Medicine
| | - Lingfeng Luo
- Human Phenome Institute, Fudan University, Shanghai, 200433, China
| | - Zheyong Huang
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China; National Clinical Research Center for Interventional Medicine
| | - Yanan Song
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China; National Clinical Research Center for Interventional Medicine
| | - Jiatian Cao
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China; National Clinical Research Center for Interventional Medicine
| | - Xueyi Weng
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China; National Clinical Research Center for Interventional Medicine
| | - Feng Zhang
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China; National Clinical Research Center for Interventional Medicine
| | - Xiaofeng Zhou
- Human Phenome Institute, Fudan University, Shanghai, 200433, China
| | - Juying Qian
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China; National Clinical Research Center for Interventional Medicine.
| | - Junbo Ge
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China; National Clinical Research Center for Interventional Medicine.
| | - Yan Zheng
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China; State Key Laboratory of Genetic Engineering, School of Life Sciences and Human Phenome Institute, Fudan University, Shanghai, China.
| |
Collapse
|
2
|
Mahowald MK, Esmail K, Ezzeddine FM, Choi C, Mieszczanska H, Velarde G. Sex Disparities in Cardiovascular Disease. Methodist Debakey Cardiovasc J 2024; 20:107-119. [PMID: 38495656 PMCID: PMC10941692 DOI: 10.14797/mdcvj.1328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 01/30/2024] [Indexed: 03/19/2024] Open
Abstract
Cardiovascular disease is the leading cause of death in women. It remains underdiagnosed, undertreated, and portends worse outcomes in women than men. Disparities exist in every stage of science, from bench research to the editorial board of major journals and in every cardiovascular subspecialty. This review summarizes differences in cardiovascular risk factors and disparities in management and outcomes of ischemic heart disease, heart failure, aortic stenosis, and atrial fibrillation. It also provides an overview of female representation as participants and leaders of clinical trials, editorial boards, and academic institutions. Strategies to overcome these disparities are proposed with examples of successful programs.
Collapse
Affiliation(s)
| | - Khadeeja Esmail
- University of Florida College of Medicine, Jacksonville, Florida, US
| | | | - Calvin Choi
- University of Florida College of Medicine, Jacksonville, Florida, US
| | | | - Gladys Velarde
- University of Florida College of Medicine, Jacksonville, Florida, US
| |
Collapse
|
3
|
Ashraf S, Farooq U, Shahbaz A, Khalique F, Ashraf M, Akmal R, Siddal MT, Ashraf M, Ashraf S, Ashraf S, Ghufran M, Akram MK, Saboor QA. Factors Responsible for Worse Outcomes in STEMI Patients With Early vs Delayed Treatment Presenting in a Tertiary Care Center in a Third World Country. Curr Probl Cardiol 2024; 49:102049. [PMID: 37666350 DOI: 10.1016/j.cpcardiol.2023.102049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 08/23/2023] [Indexed: 09/06/2023]
Abstract
The aim of the study is to compare the outcomes among ST-segment elevation myocardial infarction (STEMI) cases with early treatment vs delayed treatment. It was a prospective comparative study on 186 patients with consecutive (nonprobability) sampling. Two groups of cases were made as per their time to get admitted to the hospital (ie, within 2 hours of symptom onset = Group A; after 2 hours of symptom onset = Group B). Patients were asked for factors causing a delay in treatment after the onset of symptoms and were monitored for STEMI outcomes. The mean age of all patients was 46.62 ± 9.76 years and there were 140 (75.27%) male and 46 (24.73%) female, and male to female ratio 3:1.Factors significant for delayed treatment vs nondelayed treatment were poor social economic status (65.6% vs 20.4%), history of chronic stable angina (33.3% vs 11.8%), delayed response in the emergency room (20.4% vs 8.6%), delayed ECG acquisition (26.9% vs 8.6%), delayed ECG interpretation (25.8% vs 4.3%), pain at night 12:00-6:00 AM (21.5% vs 9.7%) and belief that the chest pain is noncardiac (26.9% vs 3.2%). Acute heart failure was significantly greater in group B (9.7%) in comparison with group A (2.2%), re-infarction was 18.3% in group B in comparison with 7.5% group A. Similarly sustained ventricular tachycardia and ventricular fibrillation and in-hospital mortality were higher in group B (12.9%, 14%, and 12.9% respectively). Due to delayed treatment patients had higher hospital stays, and complications, like acute heart failure, re-infarction, ventricular fibrillation, and in-hospital mortality.
Collapse
Affiliation(s)
- Sohaib Ashraf
- Department of Cardiology, Shaikh Zayed Post-Graduate Medical Institute, Lahore, Pakistan
| | - Usama Farooq
- Department of Cardiology, Shaikh Zayed Post-Graduate Medical Institute, Lahore, Pakistan
| | - Amir Shahbaz
- Department of Cardiology, Shaikh Zayed Post-Graduate Medical Institute, Lahore, Pakistan.
| | - Faisal Khalique
- Department of Medicine, Lahore Medical and Dental College, Lahore, Pakistan
| | - Maryam Ashraf
- Department of Cardiology, Shaikh Zayed Post-Graduate Medical Institute, Lahore, Pakistan
| | - Rutaba Akmal
- Department of Medicine, Lahore Medical and Dental College, Lahore, Pakistan
| | - Muhammad Talha Siddal
- Department of Cardiology, Shaikh Zayed Post-Graduate Medical Institute, Lahore, Pakistan
| | - Moneeb Ashraf
- Department of Pharmacology, King Edward Medical University, Mayo Hospital, Lahore, Pakistan
| | - Shoaib Ashraf
- Department of Pharmacology, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Sidra Ashraf
- Department of Pharmacology, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Muhammad Ghufran
- Department of Pharmacology, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Muhammad Kiwan Akram
- Department of Pharmacology, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Qazi Abdul Saboor
- Department of Cardiology, Shaikh Zayed Post-Graduate Medical Institute, Lahore, Pakistan
| |
Collapse
|
4
|
Tsai CH, Kung PT, Wang SM, Tsai TH, Tsai WC. The association between the workload of emergency physicians and the outcomes of acute myocardial infarction: a population-based study. Sci Rep 2023; 13:21212. [PMID: 38040727 PMCID: PMC10692142 DOI: 10.1038/s41598-023-48150-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 11/22/2023] [Indexed: 12/03/2023] Open
Abstract
Acute myocardial infarction (AMI) is the second leading cause of mortality in Taiwan. The correlation between the workload of emergency physicians and the outcome of AMI remains unknown. To determine the effects of the workload of emergency physicians on the outcomes of AMI. We included 17 661 patients (age > 18 years) with STEMI undergoing PCI, who visited the emergency department between 2012 and 2018. We used the logistic regression model with generalized estimating equations (GEEs) to analyze the risk of death within 30 days after emergency department visit, the risk of emergency department revisits within 3 days, and the risk of readmission within 14 days in all subgroups. After covariate adjustment, the risk of mortality within 30 days after visiting the emergency department was significantly higher in the subgroup whose visiting emergency physicians had the highest workload (odds ratio [OR]: 1.39; 95% confidence interval [CI]: 1.12 to 1.72). Furthermore, the risk of revisiting the emergency department within 3 days after discharge from the hospital was significantly higher in the subgroup whose visiting emergency physicians' workload was within the second and third quartiles (OR 1.85; 95% CI 1.18 to 2.89). The workload of emergency physicians appears to be positively correlated with the mortality risk of patients with STEMI undergoing PCI.
Collapse
Affiliation(s)
- Chang-Hung Tsai
- Miao-Li General Hospital, Ministry of Health and Welfare, Miaoli City, Taiwan, ROC
- Department of Health Services Administration, China Medical University, No. 100, Section 1, Jingmao Road, Beitun District, Taichung, 406040, Taiwan, ROC
- Department of Public Health, China Medical University, Taichung, Taiwan, ROC
- Department of Senior Services Industry Management, Minghsin University of Science and Technology, Hsinchu, Taiwan, ROC
| | - Pei-Tseng Kung
- Department of Healthcare Administration, Asia University, Taichung, Taiwan, ROC
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan, ROC
| | - Shun-Mu Wang
- Department of Senior Services Industry Management, Minghsin University of Science and Technology, Hsinchu, Taiwan, ROC
| | - Tung-Han Tsai
- Department of Health Services Administration, China Medical University, No. 100, Section 1, Jingmao Road, Beitun District, Taichung, 406040, Taiwan, ROC
| | - Wen-Chen Tsai
- Department of Health Services Administration, China Medical University, No. 100, Section 1, Jingmao Road, Beitun District, Taichung, 406040, Taiwan, ROC.
| |
Collapse
|
5
|
Tsai CH, Kung PT, Wang SM, Tsai TH, Tsai WC. 24-h PCI model does affect the outcome of STEMI patients: a population-based study. Sci Rep 2023; 13:13063. [PMID: 37567948 PMCID: PMC10421952 DOI: 10.1038/s41598-023-40276-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 08/08/2023] [Indexed: 08/13/2023] Open
Abstract
Acute myocardial infarction has been the second leading cause of death in Taiwan. It's a novel issue to evaluate the relationship between the 24-h PCI service model and the outcome of STEMI patients. The objective of this study was to determine the effect of 24-h PCI service model in STEMI patients to improving survival rate. This population-based cohort study included those STEMI patients, older than 18 year-old, who had ever called emergency department from 2012 to 2018. We had two groups of our study participant, one group for STEMI patients with 24-h PCI model and the other group for STEMI patients with non-24-h PCI model. We used the Logistic regression model to analyze the risk of death within 30 days, emergency department (ED) revisits within 3 days, and readmission within 14 days. After the relevant variables were controlled, the risk of death after an ED visit among the patients with STEMI who were sent to hospitals with 24-h PCI services was significantly lower than that among the patients with STEMI who were sent to hospitals without 24-h PCI services (OR 0.85; 95% CI 0.75-0.98). However, the model could not reduce the risk of ER revisits and readmission.
Collapse
Affiliation(s)
- Chang-Hung Tsai
- Miao-Li General Hospital, Ministry of Health and Welfare, Miaoli, Taiwan, R.O.C
- Department of Health Services Administration, China Medical University, No. 100, Section 1, Jingmao Road, Beitun District, Taichung City, 406040, Taiwan, R.O.C
- Department of Public Health, China Medical University, Taichung City, Taiwan, R.O.C
- Department of Senior Services Industry Management, Minghsin University of Science and Technology, Hsinchu, Taiwan, R.O.C
| | - Pei-Tseng Kung
- Department of Healthcare Administration, Asia University, Taichung City, Taiwan, R.O.C
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung City, Taiwan, R.O.C
| | - Shun-Mu Wang
- Department of Senior Services Industry Management, Minghsin University of Science and Technology, Hsinchu, Taiwan, R.O.C
| | - Tung-Han Tsai
- Department of Health Services Administration, China Medical University, No. 100, Section 1, Jingmao Road, Beitun District, Taichung City, 406040, Taiwan, R.O.C
| | - Wen-Chen Tsai
- Department of Health Services Administration, China Medical University, No. 100, Section 1, Jingmao Road, Beitun District, Taichung City, 406040, Taiwan, R.O.C..
| |
Collapse
|
6
|
Kim YH, Her AY, Rha SW, Choi CU, Choi BG, Park S, Kang DO, Cho JR, Park JY, Park SH, Jeong MH. Three-Year Clinical Outcomes Based on Pre-Percutaneous Coronary Intervention Coronary Blood Flow Grade and Symptom-to-Balloon Time in Patients with Non-ST-Segment Elevation Myocardial Infarction. J Clin Med 2023; 12:jcm12113654. [PMID: 37297849 DOI: 10.3390/jcm12113654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 05/17/2023] [Accepted: 05/22/2023] [Indexed: 06/12/2023] Open
Abstract
We compared the 3-year clinical outcomes according to the degree of pre-percutaneous coronary intervention thrombolysis in myocardial infarction flow grade (pre-PCI TIMI) and symptom-to-balloon time (SBT) individuals who underwent successful stent implantation with a diagnosis of non-ST-segment elevation myocardial infarction (NSTEMI). A total of 4910 patients with NSTEMI were divided into two groups: pre-PCI TIMI 0/1 (SBT < 48 h: n = 1328, SBT ≥ 48 h: n = 558) and pre-PCI TIMI 2/3 (SBT < 48 h: n = 1965, SBT ≥ 48 h: n = 1059). The primary outcome was a 3-year all-cause death rate, and the secondary outcome was the composite endpoint of 3-year all-cause death, recurrent MI, or any repeat revascularization rate. After adjustment, in the pre-PCI TIMI 0/1 group, the 3-year all-cause death (p = 0.003), cardiac death (CD, p < 0.001), and secondary outcome (p = 0.030) values were significantly higher in the SBT ≥ 48 h group than in the SBT < 48 h group. However, patients with pre-PCI TIMI 2/3 had similar primary and secondary outcomes, regardless of the SBT group. Within the SBT < 48 h group, the pre-PCI TIMI 2/3 group exhibited significantly higher rates of 3-year all-cause death, CD, recurrent MI, and secondary outcome values than the pre-PCI TIMI 0/1 group. Patients in the SBT ≥ 48 h group with either pre-PCI TIMI 0/1 or TIMI 2/3 had similar primary and secondary outcomes. Our results suggest that shortening the SBT may confer a survival benefit in patients with NSTEMI and those in the pre-PCI TIMI 0/1 group compared to those in the pre-PCI TIMI 2/3 group.
Collapse
Affiliation(s)
- Yong Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Kangwon National University College of Medicine, Kangwon National University School of Medicine, Chuncheon 24289, Republic of Korea
| | - Ae-Young Her
- Division of Cardiology, Department of Internal Medicine, Kangwon National University College of Medicine, Kangwon National University School of Medicine, Chuncheon 24289, Republic of Korea
| | - Seung-Woon Rha
- Cardiovascular Center, Korea University Guro Hospital, Seoul 08308, Republic of Korea
| | - Cheol Ung Choi
- Cardiovascular Center, Korea University Guro Hospital, Seoul 08308, Republic of Korea
| | - Byoung Geol Choi
- Cardiovascular Research Institute, Korea University College of Medicine, Seoul 02841, Republic of Korea
| | - Soohyung Park
- Cardiovascular Center, Korea University Guro Hospital, Seoul 08308, Republic of Korea
| | - Dong Oh Kang
- Cardiovascular Center, Korea University Guro Hospital, Seoul 08308, Republic of Korea
| | - Jung Rae Cho
- Cardiology Division, Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul 07441, Republic of Korea
| | - Ji Young Park
- Division of Cardiology, Department of Internal Medicine, Cardiovascular Center, Nowon Eulji Medical Center, Eulji University, Seoul 01830, Republic of Korea
| | - Sang-Ho Park
- Cardiology Department, Soonchunhyang University Cheonan Hospital, Cheonan 31151, Republic of Korea
| | - Myung Ho Jeong
- Department of Cardiology, Cardiovascular Center, Chonnam National University Hospital, Gwangju 61469, Republic of Korea
| |
Collapse
|
7
|
Kim YH, Her AY, Rha SW, Choi CU, Choi BG, Kim JB, Kang DO, Park JY, Park SH, Jeong MH. Effects of delayed hospitalization on the 3-year clinical outcomes of patients with or without diabetes who had non-ST-segment-elevation myocardial infarction and underwent new-generation drug-eluting stent implantation. Catheter Cardiovasc Interv 2023; 101:1014-1027. [PMID: 36923997 DOI: 10.1002/ccd.30630] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 02/20/2023] [Accepted: 03/03/2023] [Indexed: 03/18/2023]
Abstract
Clinical outcomes after non-ST-segment-elevation myocardial infarction (NSTEMI) in patients with (symptom-to-door time [SDT] ≥ 24 h) or without (SDT < 24 h) delayed hospitalization among patients with or without diabetes were compared. From the Korea Acute Myocardial Infarction Registry-National Institute of Health, a total of 4517 patients with NSTEMI who underwent new-generation drug-eluting stents implantation were recruited and they were classified into the diabetes mellitus (DM) and non-DM groups. These two groups were subdivided into groups with and without delayed hospitalization. The primary clinical outcome was the occurrence of major adverse cardiac and cerebrovascular events (MACCE), defined as all-cause death, recurrent myocardial infarction, repeat coronary revascularization, and stroke. The secondary clinical outcome was the occurrence of individual components of MACCE and stent thrombosis. Although after multivariable and propensity score-adjusted analyses in the DM group, the primary and secondary clinical outcomes between the SDT < 24 h and SDT ≥ 24 h groups were similar; in the non-DM group, all-cause (p = 0.003 and p = 0.007, respectively) and cardiac (p = 0.001 and p = 0.008, respectively) death rates were significantly higher in the SDT ≥ 24 h group than in the SDT < 24 h group. Our results suggested that there was no significant difference in prognosis between diabetic patients with and without delayed SDT, but delayed SDT was associated with poor prognosis in nondiabetic patients.
Collapse
Affiliation(s)
- Yong Hoon Kim
- Department of Internal Medicine, Division of Cardiology, Kangwon National University School of Medicine, Chuncheon, Republic of Korea
| | - Ae-Young Her
- Department of Internal Medicine, Division of Cardiology, Kangwon National University School of Medicine, Chuncheon, Republic of Korea
| | - Seung-Woon Rha
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Cheol Ung Choi
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Byoung Geol Choi
- Cardiovascular Research Institute, Korea University College of Medicine, Seoul, Republic of Korea
| | - Ji Bak Kim
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Dong Oh Kang
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Ji Young Park
- Department of Internal Medicine, Division of Cardiology, Cardiovascular Center, Nowon Eulji Medical Center, Eulji University, Seoul, Republic of Korea
| | - Sang-Ho Park
- Cardiology Department, Soonchunhyang University Cheonan Hospital, Cheonan, Republic of Korea
| | - Myung Ho Jeong
- Department of Cardiology, Cardiovascular Center, Chonnam National University Hospital, Gwangju, Republic of Korea
| |
Collapse
|
8
|
Sex Differences in Delayed Hospitalization in Patients with Non-ST-Segment Elevation Myocardial Infarction Undergoing New-Generation Drug-Eluting Stent Implantation. J Clin Med 2023; 12:jcm12051982. [PMID: 36902769 PMCID: PMC10003952 DOI: 10.3390/jcm12051982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 02/22/2023] [Accepted: 02/28/2023] [Indexed: 03/06/2023] Open
Abstract
We compared the effects of sex differences in delayed hospitalization (symptom-to-door time [SDT], ≥24 h) on major clinical outcomes in patients with non-ST-segment elevation myocardial infarction after new-generation drug-eluting stent implantation. A total of 4593 patients were classified into groups with (n = 1276) and without delayed hospitalization (SDT < 24 h, n = 3317). Thereafter, these two groups were subdivided into male and female groups. The primary clinical outcomes were major adverse cardiac and cerebrovascular events (MACCE), defined as all-cause death, recurrent myocardial infarction, repeat coronary revascularization, and stroke. The secondary clinical outcome was stent thrombosis. After multivariable- and propensity score-adjusted analyses, in-hospital mortalities were similar between the male and female groups in both the SDT < 24 h and SDT ≥ 24 h groups. However, during a 3-year follow-up period, in the SDT < 24 h group, all-cause death (p = 0.013 and p = 0.005, respectively) and cardiac death (CD, p = 0.015 and p = 0.008, respectively) rates were significantly higher in the female group than those in the male group. This may be related to the lower all-cause death and CD rates (p = 0.022 and p = 0.012, respectively) in the SDT < 24 h group than in the SDT ≥ 24 h group among male patients. Other outcomes were similar between the male and female groups and between the SDT < 24 h and SDT ≥ 24 h groups. In this prospective cohort study, female patients showed higher 3-year mortality, especially in the SDT < 24 h, compared to male patients.
Collapse
|
9
|
Muacevic A, Adler JR, Torozyan S, Plotnikova K, Ashurov M, Veprintseva A, Kimutsadze V, Kimutsadze V, Hakobova R, Kazaryan N. Total Ischemic Time on In-Hospital Complication Predictor in ST-Elevation Myocardial Infarction (STEMI) Patients With Renal Dysfunction. Cureus 2023; 15:e33903. [PMID: 36819448 PMCID: PMC9937643 DOI: 10.7759/cureus.33903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2023] [Indexed: 01/19/2023] Open
Abstract
Aim The purpose of this study was to examine the impact of total ischemic time (TIT) on in-hospital complications in acute ST-elevation myocardial infarction (STEMI) patients with renal dysfunction (RD). Methods The study included a total of 116 patients. All patients underwent percutaneous coronary intervention. Glomerular filtration rate (GFR) was < 60 ml/min/1.73 m2 in all patients. The patients were split into two groups based on the TIT value. All eligible patients were assigned to two groups according to TIT: Group 1 comprised 54 patients with ≤ 6-hour TIT and Group 2 consisted of 62 patients with > 6-hour TIT. The groups' other characteristics were similar. The composite rate of pulmonary edema and cardiogenic shock were compared between groups. Results The mean TIT in Group 1 was 4.37 ± 1.35 and in Group 2 was 9.03 ± 1.59 (p < 0.0001). The incidence of pulmonary edema or cardiogenic shock was higher in Group 2 than in Group 1: 16.1% and 3.7%, respectively (p = 0.034). Conclusion STEMI patients with RD and higher TIT were more likely to develop pulmonary edema and cardiogenic shock.
Collapse
|
10
|
A Deep Learning Algorithm for Detecting Acute Pericarditis by Electrocardiogram. J Pers Med 2022; 12:jpm12071150. [PMID: 35887647 PMCID: PMC9324403 DOI: 10.3390/jpm12071150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 07/02/2022] [Accepted: 07/13/2022] [Indexed: 12/20/2022] Open
Abstract
(1) Background: Acute pericarditis is often confused with ST-segment elevation myocardial infarction (STEMI) among patients presenting with acute chest pain in the emergency department (ED). Since a deep learning model (DLM) has been validated to accurately identify STEMI cases via 12-lead electrocardiogram (ECG), this study aimed to develop another DLM for the detection of acute pericarditis in the ED. (2) Methods: This study included 128 ECGs from patients with acute pericarditis and 66,633 ECGs from patients visiting the ED between 1 January 2010 and 31 December 2020. The ECGs were randomly allocated based on patients to the training, tuning, and validation sets, at a 3:1:1 ratio. We used raw ECG signals to train a pericarditis-DLM and used traditional ECG features to train a machine learning model. A human–machine competition was conducted using a subset of the validation set, and the performance of the Philips automatic algorithm was also compared. STEMI cases in the validation set were extracted to analyze the DLM ability of differential diagnosis between acute pericarditis and STEMI using ECG. We also followed the hospitalization events in non-pericarditis cases to explore the meaning of false-positive predictions. (3) Results: The pericarditis-DLM exceeded the performance of all participating human experts and algorithms based on traditional ECG features in the human–machine competition. In the validation set, the pericarditis-DLM could detect acute pericarditis with an area under the receiver operating characteristic curve (AUC) of 0.954, a sensitivity of 78.9%, and a specificity of 97.7%. However, our pericarditis-DLM also misinterpreted 10.2% of STEMI ECGs as pericarditis cases. Therefore, we generated an integrating strategy combining pericarditis-DLM and a previously developed STEMI-DLM, which provided a sensitivity of 73.7% and specificity of 99.4%, to identify acute pericarditis in patients with chest pains. Compared to the true-negative cases, patients with false-positive results using this strategy were associated with higher risk of hospitalization within 3 days due to cardiac disorders (hazard ratio (HR): 8.09; 95% confidence interval (CI): 3.99 to 16.39). (4) Conclusions: The AI-enhanced algorithm may be a powerful tool to assist clinicians in the early detection of acute pericarditis and differentiate it from STEMI using 12-lead ECGs.
Collapse
|
11
|
Balbaa A, ElGuindy A, Pericak D, Natarajan MK, Schwalm JD. Before the door: Comparing factors affecting symptom onset to first medical contact for STEMI patients between a high and low-middle income country. INTERNATIONAL JOURNAL OF CARDIOLOGY. HEART & VASCULATURE 2022; 39:100978. [PMID: 35402688 PMCID: PMC8984626 DOI: 10.1016/j.ijcha.2022.100978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 02/05/2022] [Accepted: 02/18/2022] [Indexed: 10/25/2022]
Abstract
Background Early reperfusion in patients with ST-segment elevation myocardial infarction (STEMI) has been associated with preservation of left ventricular function and decrease in mortality. Symptom onset to first medical contact (FMC) time consumes the majority of total ischemic time, and remains one of the main reasons that patients do not receive timely care. With FMC to reperfusion time being effectively reduced in many parts of the world, the focus is now shifting to reducing symptom onset to FMC times. Methods This mixed-methods observational study was designed to elucidate factors affecting symptom onset to FMC time at a regional cardiac center in a low-middle income country (LMIC) and a high-income country (HIC). A review of the Aswan Heart Center and Hamilton General Hospital STEMI registry in Egypt and Canada was conducted, and retrospective semi-structured questionnaires carried out for a convenience sample of 158 patients. Results Gender, symptom type and severity were none-modifiable factors found between early and late presenters. Modifiable factors found were actions of bystanders, actions of patients, transportation method and time. Emotional factors also showed differences between the two groups. Conclusion While some concepts are generalizable, contextual differences in demographics, risk factors, access and knowledge are identified. These factors can be used to inform tailored knowledge translation strategies to help reduce symptom onset to FMC in both LMIC and HIC.
Collapse
Key Words
- AHC, Aswan Heart Center
- Barriers
- DM, Diabetes Miletus
- EMS, Emergency medical services
- FMC, first medical contact
- Fist medical contact
- HGH, Hamilton General Hospital
- HIC, High-income country
- HT, Hypertension
- LMIC, low- and middle-income countries
- Low-middle income
- MI, Myocardial infarction
- REB, Research ethics board
- RSQ, Response to Systems Questionnaire
- SD, standard deviation
- SO, Symptom onset
- STEMI
- STEMI, ST-segment elevation myocardial infarction
- Symptom onset
Collapse
Affiliation(s)
- Amira Balbaa
- University of Toronto, Faculty of Medicine, Toronto, ON, Canada
| | - Ahmed ElGuindy
- Department of Cardiology, Aswan Heart Centre - Magdi Yacoub Foundation. Aswan, Egypt
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Dan Pericak
- McMaster University, Department of Medicine, Hamilton, ON, Canada
| | - Madhu K Natarajan
- McMaster University, Department of Medicine, Hamilton, ON, Canada
- McMaster University, Department of Medicine, Division of Cardiology, Hamilton, Canada
- Population Health Research Institute, Hamilton, Canada
| | - J D Schwalm
- McMaster University, Department of Medicine, Hamilton, ON, Canada
- McMaster University, Department of Medicine, Division of Cardiology, Hamilton, Canada
- Population Health Research Institute, Hamilton, Canada
| |
Collapse
|
12
|
Najafi H, Bahramali E, Bijan M, Dehghan A, Amirkhani M, Balaghi inaloo M. Comparison of the outcomes of EMS vs. Non-EMS transport of patients with ST-segment elevation myocardial infarction (STEMI) in Southern Iran: a population-based study. BMC Emerg Med 2022; 22:46. [PMID: 35331145 PMCID: PMC8944078 DOI: 10.1186/s12873-022-00603-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 03/08/2022] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND In the medical management of acute myocardial infarction, the transport of patients and primary care provided by emergency medical technicians (EMTs) and paramedics are effective in reducing the mortality and disabilities. Therefore, the present study aimed to compare the outcomes of emergency medical services (EMS) vs. non-EMS transport of patients with ST-segment elevation myocardial infarction (STEMI) in southern Iran. METHODS This is an analytical, cross-sectional study. The study population consisted of the individuals registered in Fasa Registry on Acute Myocardial Infarction (FaRMI) in the south of Iran. 2244 patients with STEMI were included in the study. Statistical analyses were performed using Chi-Square test and independent t-test at a significance level of P < 0.05 in SPSS 22. RESULTS Out of the 2244 patients with STEMI, 1552 (69.16%) were male and 672 patients (29.94%) were female. 934(41.62%) patients used EMS transport to the hospital, while 1310 (58.37%) patients used non-EMS transport to the hospital. A total of 169 patients with STEMI (7.26%) expired (out-of-hospital cardiac arrest); of them, 113 (66.86%) patients did not use EMS transport to the hospital. Successful cardiopulmonary resuscitation (CPR) was performed on 52 patients who used EMS transport. 27 patients also received an effective DC shock due to ventricular fibrillation (VF). Of the total number of patients, 49 had a stroke; among them, 37(75.51%) patients did not use EMS transport. CONCLUSION In the present study, the death rate in patients with acute myocardial infarction who used EMS transport was lower than those who used non-EMS transport. The health system managers and policymakers in the healthcare systems are recommended to take the necessary measures to increase public health awareness and knowledge about the use of EMS and consequently reduce the death rate and complications of acute myocardial infarction.
Collapse
Affiliation(s)
- Hjatolah Najafi
- Department of Health in Disasters and Emergencies, School of Management and Medical Information, Health Human Resources Research Center, University of Medical Sciences, ShirazShiraz, Iran
| | - Ehsan Bahramali
- Noncommunicable Diseases Research Center (NCDRC), Fasa University of Medical Sciences, Fasa, Iran
| | - Mostafa Bijan
- Department of Medical Surgical Nursing, Fasa University of Medical Sciences, 81936-13119 Fasa, Iran
| | - Azizallah Dehghan
- Noncommunicable Diseases Research Center (NCDRC), Fasa University of Medical Sciences, Fasa, Iran
| | - Mehdi Amirkhani
- Department of Health in Disasters and Emergencies, School of Management and Medical Information, Health Human Resources Research Center, University of Medical Sciences, ShirazShiraz, Iran
| | - Maryam Balaghi inaloo
- Noncommunicable Diseases Research Center (NCDRC), Fasa University of Medical Sciences, Fasa, Iran
| |
Collapse
|
13
|
Kurmi P, Tripathi VD, Tripathi SK. Impact of Total Ischemic Time on Clinical Outcomes in Patients With ST-Elevation Myocardial Infarction: Lost Time Is Never Found Again. Cureus 2022; 14:e23143. [PMID: 35433148 PMCID: PMC9006868 DOI: 10.7759/cureus.23143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction A dedicated relationship between total ischemic time (TIT) and clinical outcomes has been reported in ST-elevation myocardial infarction (STEMI) patients undergoing percutaneous coronary intervention (PCI); however, this claim is yet to be clarified. Accordingly, this study was carried out to determine the association of TIT with in-hospital and one-year follow-up outcomes in STEMI patients undergoing primary PCI. Material and methodology Between December 2020 and December 2021, a total of 113 consecutive STEMI patients undergoing primary PCI were prospectively included. According to TIT, all patients were categorized into two groups: (a) shorter TIT (<180 minutes) and (b) prolonged TIT (≥180 minutes). Data regarding baseline, clinical, and angiographic characteristics, as well as in-hospital and one-year follow-up outcomes were noted among the two groups. Results A total of 113 STEMI patients with a mean age of 69.3 ± 13.6 years were studied, and males [92 (81.4%)] were predominately affected with STEMI. A median TIT was 348 minutes. Of 113, 30 (23.0%) patients had a TIT of <180 minutes and 83 (73.5%) had a TIT of ≥180 minutes. Prolonged ischemia duration was significantly associated with composite of death, rehospitalization, and revascularization (p=0.02) at one-year follow-up. Conclusion TIT can be considered a good quality indicator, together with door-to-balloon time and other clinical determinants, in order to improve survival in STEMI patients.
Collapse
|
14
|
Gao N, Qi X, Dang Y, Li Y, Wang G, Liu X, Zhu N, Fu J. Association between total ischemic time and in-hospital mortality after emergency PCI in patients with acute ST-segment elevation myocardial infarction: a retrospective study. BMC Cardiovasc Disord 2022; 22:80. [PMID: 35246059 PMCID: PMC8896149 DOI: 10.1186/s12872-022-02526-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 02/24/2022] [Indexed: 11/10/2022] Open
Abstract
Background Symptom-to-balloon time (SBT) represents the total ischemic time in ST-elevated myocardial infarction (STEMI) and is associated with poor long-term outcomes. The study aimed to explore the association between SBT and in-hospital mortality after emergency percutaneous coronary intervention (PCI) in patients with acute STEMI. Methods This retrospective, multicenter, observational study included patients admitted to the Hebei General Hospital, Baoding No. 1 Central Hospital, and Cangzhou Central Hospital from January 2016 to December 2018. The outcome was all-cause mortality during the hospital stay. Logistic regression models were established to explore the association between SBT and all-cause mortality during the hospital stay. Results This study included 1169 patients: 876 males of 59.6 ± 11.4 years of age, and 293 females 66.3 ± 13.3 years of age. A first analysis showed EF had an interaction with SBT (P = 0.01). In patients with EF ≥ 50%, SBT was not an independent risk factor for postoperative all-cause mortality in the hospital (all P > 0.05). In patients with EF < 50%, SBT was an independent risk factor for postoperative all-cause mortality in the hospital [model 3: 1.51 (1.17, 1.54), P for trend = 0.01]. Conclusions SBT was independently associated with all-cause mortality in the hospital after PCI in patients with acute STEMI and EF < 50%. Specifically, the risk of in-hospital mortality for those with SBT ≥ 361 min is increased by 51% compared with those with SBT ≤ 120 min.
Collapse
Affiliation(s)
- Nan Gao
- School of Graduate, Hebei Medical University, No. 361 Zhongshan East Street, Changan District, Shijiazhuang, Hebei Province, 050000, People's Republic of China.,Department of Cardiology, Baoding No. 1 Central Hospital, Baoding, 071000, Hebei Province, People's Republic of China
| | - Xiaoyong Qi
- School of Graduate, Hebei Medical University, No. 361 Zhongshan East Street, Changan District, Shijiazhuang, Hebei Province, 050000, People's Republic of China. .,Department of Cardiology, Hebei General Hospital, Shijiazhuang, 050000, Hebei Province, People's Republic of China.
| | - Yi Dang
- Department of Cardiology, Hebei General Hospital, Shijiazhuang, 050000, Hebei Province, People's Republic of China
| | - Yingxiao Li
- Department of Cardiology, Hebei General Hospital, Shijiazhuang, 050000, Hebei Province, People's Republic of China
| | - Gang Wang
- Department of Cardiology, Cangzhou Central Hospital, Cangzhou, 061000, Hebei Province, People's Republic of China
| | - Xiao Liu
- Department of Cardiology, Hebei General Hospital, Shijiazhuang, 050000, Hebei Province, People's Republic of China
| | - Ning Zhu
- Department of Cardiology, Baoding No. 1 Central Hospital, Baoding, 071000, Hebei Province, People's Republic of China
| | - Jinguo Fu
- Department of Cardiology, Cangzhou Central Hospital, Cangzhou, 061000, Hebei Province, People's Republic of China
| |
Collapse
|
15
|
Khowaja S, Ahmed S, Kumar R, Shah JA, Khan KA, Khan NU, Saghir T, Rizvi SNH, Qamar N, Karim M. Time to think beyond door to balloon time: significance of total ischemic time in STEMI. Egypt Heart J 2021; 73:95. [PMID: 34714429 PMCID: PMC8556403 DOI: 10.1186/s43044-021-00221-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 10/21/2021] [Indexed: 11/10/2022] Open
Abstract
Background Significance of total ischemic time (TIT) in the context of ST-segment elevation myocardial infarction (STEMI) is still controversial. Therefore, in this study, we have evaluate the association of TIT with immediate outcomes in STEMI patients in whom recommended door to balloon (DTB) time of less than 90 min was achieved. Results A total of 5730 patients were included in this study, out of which 80.9% were male and median age was 55 [61–48] years. The median DTB was observed to be 60 [75–45] min and onset of chest pain to emergency room (ER) arrival time was 180 [300–120] min. Prolonged TIT was associated with poor pre-procedure thrombolysis in myocardial infarction (TIMI) flow grade (p = 0.022), number of diseased vessels (p = 0.002), use of intra-aortic balloon pump (p = 0.003), and in-hospital mortality (p = 0.002). Mortality rate was 4.5%, 5.7%, and 7.8% for the patients with TIT of ≤ 120 min, 121 to 240 min, and > 240 min, respectively. Thirty days’ risk of mortality on TIMI score was 4.97 ± 7.09%, 5.01 ± 6.99%, and 7.12 ± 8.64% for the patients with TIT of ≤ 120 min, 121 to 240 min, and > 240 min, respectively.
Conclusions Prolonged total ischemic was associated with higher in-hospital mortality. Therefore, TIT can also be considered in the matrix of focus, along with DTB time and other clinical determinants to improve the survival from STEMI.
Collapse
Affiliation(s)
- Sanam Khowaja
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan.
| | - Salik Ahmed
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - Rajesh Kumar
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - Jehangir Ali Shah
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - Kamran Ahmed Khan
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - Naveed Ullah Khan
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - Tahir Saghir
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | | | - Nadeem Qamar
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - Musa Karim
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| |
Collapse
|
16
|
Analysis of the hospitalization time impact on hospital mortality from acute myocardial infarction. EUREKA: HEALTH SCIENCES 2021. [DOI: 10.21303/2504-5679.2021.001813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Diseases of the circulatory system and their most severe form – acute myocardial infarction (AMI) – is one of the most important problems of modern medicine due to the steady increase in morbidity, negative impact on quality of life, early disability of patients. 19.5 % of patients die from AMI, 50 % among which die 90-120 minutes after the first symptoms of the disease.
The aim of the research was to analyse the impact of hospitalization on the mortality of patients with AMI and predict the risk of death in case of untimely hospitalization of this category of patients.
Materials and methods. We have conducted a retrospective analysis of 876 medical records of patients diagnosed with AMI who were treated in the cardiology department of Kharkiv Regional Clinical Hospital in 2019. During the study, we have used retrospective, logical, medical and statistical methods. Odds ratios and a 95 % confidence interval were also calculated.
Results and discussion. The research revealed the impact of hospitalization on the organization of medical care and hospital mortality of patients with AMI. It was found that the largest share of patients with AMI, both among the dead and those who left the hospital, were hospitalized in the period from 2 to 12 hours from the onset of the disease (49.6 % and 52.33 %, respectively), as well as in period after 24 hours – 28.00 % and 21.70 %, respectively. The largest share of patients with AMI, regardless of the time of hospitalization were persons older than 60 years. The results of the analysis showed that in the period up to 2 h from the onset of the disease, the share of hospitalized patients with more severe heart muscle damage (presence of Q wave) was 91.35 % against 8.65 % of patients with AMI without ST segment elevation. It should be noted that in almost 50 % of cases, patients with AMI without ST segment elevation were hospitalized after 24 h from the onset of the disease. At the same time, the largest share of deaths in this group of patients was observed in the hospital stay from 12 to 24 hours. According to the results of the research, risk factors for fatal outcome in AMI were identified, in particular male gender, the presence of an established ECG diagnosis of NSTEMI, conducting SKA in patients with AMI. It was also found that timely hospitalization of patients within the therapeutic window reduces the chances of hospital mortality by 52 %.
Conclusions. The obtained data indicate a strong relationship between the time of hospitalization and the organization of medical care and hospital mortality of patients with AMI. It is reliably established that timely hospitalization of patients within the therapeutic window reduces the chances of hospital mortality by 52 %: HS is 0.483 (95 % CI 0.238 – 0.981), p=0.175.
Collapse
|
17
|
Scholz KH, Meyer T, Lengenfelder B, Vahlhaus C, Tongers J, Schnupp S, Burckhard R, von Beckerath N, Grusnick HM, Jeron A, Winter KD, Maier SKG, Danner M, Vom Dahl J, Neef S, Stefanow S, Friede T. Patient delay and benefit of timely reperfusion in ST-segment elevation myocardial infarction. Open Heart 2021; 8:e001650. [PMID: 33958491 PMCID: PMC8103948 DOI: 10.1136/openhrt-2021-001650] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 04/02/2021] [Accepted: 04/06/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND In patients with ST-segment elevation myocardial infarction (STEMI), it is unknown how patient delay modulates the beneficial effects of timely reperfusion. AIMS To assess the prognostic significance of a contact-to-balloon time of less than 90 min on in-hospital mortality in different categories of symptom-onset-to-first-medical-contact (S2C) times. METHODS A total of 20 005 consecutive patients from the Feedback Intervention and Treatment Times in ST-segment Elevation Myocardial Infarction (FITT-STEMI) programme treated with primary percutaneous coronary intervention (PCI) were included. RESULTS There were 1554 deaths (7.8%) with a J-shaped relationship between mortality and S2C time. Mortality was 10.0% in patients presenting within 1 hour, and 4.9%, 6.0% and 7.3% in patient groups with longer S2C intervals of 1-2 hours, 2-6 hours and 6-24 hours, respectively. Patients with a short S2C interval of less than 1 hour (S2C<60 min) had the highest survival benefit from timely reperfusion with PCI within 90 min (OR 0.27, 95% CI 0.23 to 0.31, p<0.0001) as compared with the three groups with longer S2C intervals of 1 hour CONCLUSIONS Timely reperfusion with a contact-to-balloon time of less than 90 min is most effective in patients presenting with short S2C intervals of less than 1 hour, but has also beneficial effects in patients with S2C intervals of up to 24 hours. TRIAL REGISTRATION NUMBER NCT00794001.
Collapse
Affiliation(s)
- Karl Heinrich Scholz
- Department of Cardiology and Intensive Care, St Bernward Hospital, Hildesheim, Germany
| | - Thomas Meyer
- Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen, Göttingen, Germany, and DZHK (German Centre for Cardiovascular Research), partner site Göttingen, Göttingen, Germany
| | | | - Christian Vahlhaus
- Department of Cardiology and Angiology, University Hospital Münster, Münster, Germany
| | - Jörn Tongers
- Department of Cardiology, Medizinische Hochschule Hannover, Hannover, Germany
| | | | - Rainer Burckhard
- Department of Cardiology, Donauisar Klinikum Deggendorf, Deggendorf, Germany
| | | | | | - Andreas Jeron
- Department of Cardiology, Rems-Murr-Kliniken, Winnenden, Germany
| | | | - Sebastian K G Maier
- Department of Cardiology, Klinikum Sankt Elisabeth Straubing, Straubing, Germany
| | - Michael Danner
- Department of Cardiology, Städtisches Klinikum, München Neuperlach, Munich, Germany
| | - Jürgen Vom Dahl
- Department of Cardiology, Kliniken Maria Hilf, Mönchengladbach, Germany
| | - Stefan Neef
- Department of Cardiology, University Hospital Regensburg, Regensburg, Germany
| | - Stefan Stefanow
- Department of Cardiology, Klinikum Ludwigsburg, Ludwigsburg, Ludwigsburg, Germany
| | - Tim Friede
- Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany, and DZHK (German Centre for Cardiovascular Research), partner site Göttingen, Göttingen, Germany
| |
Collapse
|
18
|
Bessonov IS, Kuznetsov VA, Gorbatenko EA, Dyakova AO, Sapozhnikov SS. Influence of Total Ischemic Time on Clinical Outcomes in Patients with ST-Segment Elevation Myocardial Infarction. ACTA ACUST UNITED AC 2021; 61:40-46. [PMID: 33734047 DOI: 10.18087/cardio.2021.2.n1314] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 11/11/2020] [Accepted: 11/24/2020] [Indexed: 11/18/2022]
Abstract
Aim To evaluate the effect of the total time of myocardial ischemia on results of the treatment of patients with ST segment elevation acute myocardial infarction (STEMI) who underwent percutaneous coronary interventions (PCI).Material and methods This study used data from a hospital register for PCI in STEMI from 2006 through 2017. 1649 patients were included. Group 1 consisted of 604 (36.6 %) patients with a total time of myocardial ischemia not exceeding 1880 min; group 2 included 531 (32.2 %) patients with a duration of myocardial ischemia from 180 to 360 min; and group 3 included 514 (31.2 %) patients with a duration of myocardial ischemia longer than 360 min.Results Mortality was lower in group 1 (2.3 %) than in groups 2 and 3 (6.2 and 7.2 %, respectively; p1-2=0.001; p1-3<0.001; p2-3=0.520). The incidence of major cardiac complications ("adverse cardiac events", MACE) was lower in group 1 (4.1 %) than in groups 2 and 3 (7.3 and 9.5 %, respectively, p1-2=0.020; p1-3<0.001; p2-3=0.200). The incidence of no-reflow phenomenon was higher in group 3 (9.7 %) than in groups 2 and 3 (4.5 and 5.3 %, respectively (p1-2=0.539; p1-3=0.001; p2-3=0.005). The major factors associated with the increased total time of myocardial ischemia >180 min were age (odd ratio, OR, 1.01 at 95 % confidence interval, CI, 1.0 to 1.02; р=0.044), female gender (OR, 1.64 at 95 % CI 1.26 to 2.13; р<0.001), chronic kidney disease (OR 1.82 at 95 % CI 1.21 to 2.74; р=0.004). Performing prehospital thrombolysis was associated with a decrease in the total time of myocardial ischemia (OR 0.4 at 95 % CI 0.31 to 0.51; р<0.001). A strong direct correlation was observed between the total time of myocardial ischemia and the time from the onset of pain syndrome to hospitalization (r=0.759; р<0.001).Conclusion The total time of myocardial ischemia >180 min was associated with increased mortality and development of MACE. The total time of myocardial ischemia > 360 min was associated with increased incidence of the no-reflow phenomenon. The major predictors for the time of myocardial ischemia >180 min included age, female gender, and chronic kidney disease. The use of pharmacoinvasive strategy was associated with an increased number of patients with a total duration of myocardial ischemia <180 min. The contribution of the time of prehospital delay to the total time of myocardial ischemia was greater than the contribution of the "door-to-balloon" time. The time of prehospital delay showed a strong direct correlation with the total time of myocardial ischemia.
Collapse
Affiliation(s)
- I S Bessonov
- Tyumen Cardiology Research Center, Tomsk National Research Medical Center, Russian Academy of Science, Tomsk
| | - V A Kuznetsov
- Tyumen Cardiology Research Center, Tomsk National Research Medical Center, Russian Academy of Science, Tomsk
| | - E A Gorbatenko
- Tyumen Cardiology Research Center, Tomsk National Research Medical Center, Russian Academy of Science, Tomsk
| | - A O Dyakova
- Tyumen Cardiology Research Center, Tomsk National Research Medical Center, Russian Academy of Science, Tomsk
| | - S S Sapozhnikov
- Tyumen Cardiology Research Center, Tomsk National Research Medical Center, Russian Academy of Science, Tomsk
| |
Collapse
|
19
|
Redfors B, Mohebi R, Giustino G, Chen S, Selker HP, Thiele H, Patel MR, Udelson JE, Ohman EM, Eitel I, Granger CB, Maehara A, Ali ZA, Ben-Yehuda O, Stone GW. Time Delay, Infarct Size, and Microvascular Obstruction After Primary Percutaneous Coronary Intervention for ST-Segment-Elevation Myocardial Infarction. Circ Cardiovasc Interv 2021; 14:e009879. [PMID: 33440999 DOI: 10.1161/circinterventions.120.009879] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Symptom-to-balloon time (SBT) and door-to-balloon time (DBT) are both considered important metrics in patients undergoing primary percutaneous coronary intervention (pPCI) for ST-segment-elevation myocardial infarction (STEMI). We sought to assess the relationship of SBT and DBT with infarct size and microvascular obstruction (MVO) after pPCI. METHODS Individual patient data for 3115 ST-segment-elevation myocardial infarction patients undergoing pPCI in 10 randomized trials were pooled. Infarct size (% left ventricular mass) was assessed within 1 month after randomization by technetium-99 m sestamibi single-photon emission computerized tomography (3 studies) or cardiac magnetic resonance imaging (7 studies). MVO was assessed by cardiac magnetic resonance. Patients were stratified by short (≤2 hours), intermediate (2-4 hours), or long (>4 hours) SBTs, and by short (≤45 minutes), intermediate (45-90 minutes), or long (>90 minutes) DBTs. RESULTS Median [interquartile range] SBT and DBT were 185 [130-269] and 46 [28-83] minutes, respectively. Median [interquartile range] time to infarct size assessment after pPCI was 5 [3-12] days. There was a stepwise increase in infarct size according to SBT category (adjusted difference, 2.0% [95% CI, 0.4-3.5] for intermediate versus short SBT and 4.4% [95% CI, 2.7-6.1] for long versus short SBT) but not according to DBT category (adjusted difference, 0.4% [95% CI, -1.2 to 1.9] for intermediate versus short DBT and -0.1% [95% CI, -1.0 to 3.0] for long versus short SBT). MVO was greater in patients with long versus short SBT (adjusted difference, 0.9% [95% CI, 0.3-1.4]) but was not different between patients with intermediate versus short SBT (adjusted difference, 0.1 [95% CI, -0.4 to 0.6]). There was no difference in MVO according to DBT. Results were similar in multivariable analysis with SBT and DBT included as continuous variables. CONCLUSIONS Among 3115 patients with ST-segment-elevation myocardial infarction undergoing infarct size assessment after pPCI, SBT was more strongly correlated with infarct size and MVO than DBT.
Collapse
Affiliation(s)
- Björn Redfors
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (B.R., R.M., S.C., A.M., Z.A.A., O.B.-Y., G.W.S.).,Department of Cardiology, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY (B.R., S.C., A.M., Z.A.A., O.B.-Y.).,Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden (B.R.)
| | - Reza Mohebi
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (B.R., R.M., S.C., A.M., Z.A.A., O.B.-Y., G.W.S.).,The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (R.M., G.G., G.W.S.)
| | - Gennaro Giustino
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (R.M., G.G., G.W.S.)
| | - Shmuel Chen
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (B.R., R.M., S.C., A.M., Z.A.A., O.B.-Y., G.W.S.).,Department of Cardiology, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY (B.R., S.C., A.M., Z.A.A., O.B.-Y.)
| | - Harry P Selker
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA (H.P.S.)
| | - Holger Thiele
- Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Germany (H.T.)
| | - Manesh R Patel
- Duke University Medical Center, Durham, NC (M.R.P., E.M.O., C.B.G.)
| | - James E Udelson
- Division of Cardiology, Tufts Medical Center, Boston, MA (J.E.U.)
| | - E Magnus Ohman
- Duke University Medical Center, Durham, NC (M.R.P., E.M.O., C.B.G.)
| | - Ingo Eitel
- University Heart Center Lübeck, and the German Center for Cardiovascular Research, Lübeck, Germany (I.E.)
| | | | - Akiko Maehara
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (B.R., R.M., S.C., A.M., Z.A.A., O.B.-Y., G.W.S.).,Department of Cardiology, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY (B.R., S.C., A.M., Z.A.A., O.B.-Y.)
| | - Ziad A Ali
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (B.R., R.M., S.C., A.M., Z.A.A., O.B.-Y., G.W.S.).,Department of Cardiology, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY (B.R., S.C., A.M., Z.A.A., O.B.-Y.).,St. Francis Hospital, Roslyn, NY (Z.A.A.)
| | - Ori Ben-Yehuda
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (B.R., R.M., S.C., A.M., Z.A.A., O.B.-Y., G.W.S.).,Department of Cardiology, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY (B.R., S.C., A.M., Z.A.A., O.B.-Y.)
| | - Gregg W Stone
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (B.R., R.M., S.C., A.M., Z.A.A., O.B.-Y., G.W.S.).,The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (R.M., G.G., G.W.S.)
| |
Collapse
|
20
|
Reinstadler SJ, Reindl M, Lechner I, Holzknecht M, Tiller C, Roithinger FX, Frick M, Hoppe UC, Jirak P, Berger R, Delle-Karth G, Laßnig E, Klug G, Bauer A, Binder R, Metzler B. Effect of the COVID-19 Pandemic on Treatment Delays in Patients with ST-Segment Elevation Myocardial Infarction. J Clin Med 2020; 9:E2183. [PMID: 32664309 PMCID: PMC7408681 DOI: 10.3390/jcm9072183] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 06/17/2020] [Accepted: 07/02/2020] [Indexed: 01/08/2023] Open
Abstract
Coronavirus disease 19 (COVID-19) and its associated restrictions could affect ischemic times in patients with ST-segment elevation myocardial infarction (STEMI). The objective of this study was to investigate the influence of the COVID-19 outbreak on ischemic times in consecutive all-comer STEMI patients. We included consecutive STEMI patients (n = 163, median age: 61 years, 27% women) who were referred to seven tertiary care hospitals across Austria for primary percutaneous coronary intervention between 24 February 2020 (calendar week 9) and 5 April 2020 (calendar week 14). The number of patients, total ischemic times and door-to-balloon times in temporal relation to COVID-19-related restrictions and infection rates were analyzed. While rates of STEMI admissions decreased (calendar week 9/10 (n = 69, 42%); calendar week 11/12 (n = 51, 31%); calendar week 13/14 (n = 43, 26%)), total ischemic times increased from 164 (interquartile range (IQR): 107-281) min (calendar week 9/10) to 237 (IQR: 141-560) min (calendar week 11/12) and to 275 (IQR: 170-590) min (calendar week 13/14) (p = 0.006). Door-to-balloon times were constant (p = 0.60). There was a significant difference in post-interventional Thrombolysis in myocardial infarction (TIMI) flow grade 3 in patients treated during calendar week 9/10 (97%), 11/12 (84%) and 13/14 (81%; p = 0.02). Rates of in-hospital death and re-infarction were similar between groups (p = 0.48). Results were comparable when dichotomizing data on 10 March and 16 March 2020, when official restrictions were executed. In this cohort of all-comer STEMI patients, we observed a 1.7-fold increase in ischemic time during the outbreak of COVID-19 in Austria. Patient-related factors likely explain most of this increase. Counteractive steps are needed to prevent further cardiac collateral damage during the ongoing COVID-19 pandemic.
Collapse
Affiliation(s)
- Sebastian J Reinstadler
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
| | - Martin Reindl
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
| | - Ivan Lechner
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
| | - Magdalena Holzknecht
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
| | - Christina Tiller
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
| | | | - Matthias Frick
- Department of Cardiology, Academic Teaching Hospital Feldkirch, A-6800 Feldkirch, Austria
| | - Uta C Hoppe
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, A-5020 Salzburg, Austria
| | - Peter Jirak
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, A-5020 Salzburg, Austria
| | - Rudolf Berger
- Department of Cardiology and Internal Medicine, Hospital of St. John of God, A-7000 Eisenstadt, Austria
| | - Georg Delle-Karth
- Department of Cardiology, Vienna North Hospital, A-1210 Vienna, Austria
| | - Elisabeth Laßnig
- Department of Cardiology and Intensive Care, Klinikum Wels, A-4600 Wels, Austria
| | - Gert Klug
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
| | - Axel Bauer
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
| | - Ronald Binder
- Department of Cardiology and Intensive Care, Klinikum Wels, A-4600 Wels, Austria
| | - Bernhard Metzler
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
| |
Collapse
|
21
|
Viejo-Moreno R, Cabrejas-Aparicio A, Arriero-Fernández N, Quintana-Díaz M, Galván-Roncero E, Gálvez-Marco MDLN, Carriedo-Scher C, Balaguer-Recena J, Marian-Crespo C. Mobile Intensive Care Unit versus Hospital walk-in patients, in the treatment of first episode ST- elevation myocardial infarction. Eur J Intern Med 2020; 73:83-89. [PMID: 31874804 DOI: 10.1016/j.ejim.2019.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 12/13/2019] [Accepted: 12/15/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine the impact of the attention given by emergency medical services teams working in mobile intensive care units (MICU) versus patients arriving at the hospital under their own means with ST-elevation myocardial infarction (STEMI) event in terms of time to reperfusion (TR), mortality at 30 days and six months. METHODS We retrospectively studied 634 consecutive patients with STEMI who underwent primary a percutaneous coronary intervention from January 1st 2015 to December 31st 2018 in a single centre. Depending on the first medical contact patients were classified into two groups, MICU versus walk-in patients. We extracted data on patients' characteristics, symptoms, treatments, times to reperfusion and mortality. RESULTS In our study 634 patients were included, of whom 59.0% were initially attended by the MICU. Differences were seen between the two groups in time delays to the first medical contact (120.0 vs 63.0 min; p < 0.001) and TR (208.0 Vs 150.0 min; p < 0.001). Patients attended by the MICUs presented a shorter ICU and hospital stay. The lowest 30-day mortality rate was observed in MICU group: 9.0% in contrast with 4.5%, p = 0.03; remaining after 6 months. The multivariable analysis showed that the initial attention given by MICU to STEMI patients was a protective agent against mortality [OR: 0.32 (0.11-0.90); p = 0.03]. CONCLUSION Initial attention of the patients with STEMI by doctor-on-board-MICU and available 24 h a day 7 days a week as part of a regional network (CORECAM), was associated with a decrease in the ischemia time, hospital stay and mortality of these patients in our environment.
Collapse
Affiliation(s)
- Rubén Viejo-Moreno
- Movil intensive care unit, Gerencia de Urgencias, Emergencias y Transporte Sanitario (GUETS-SESCAM), Castilla la Mancha, España; Intensive care unit, Hospital Universitario Guadalajara, SESCAM. Guadalajara, España.
| | - Alberto Cabrejas-Aparicio
- Movil intensive care unit, Gerencia de Urgencias, Emergencias y Transporte Sanitario (GUETS-SESCAM), Castilla la Mancha, España
| | | | | | - Enrique Galván-Roncero
- Movil intensive care unit, Gerencia de Urgencias, Emergencias y Transporte Sanitario (GUETS-SESCAM), Castilla la Mancha, España
| | - María de Las Nieves Gálvez-Marco
- Movil intensive care unit, Gerencia de Urgencias, Emergencias y Transporte Sanitario (GUETS-SESCAM), Castilla la Mancha, España.
| | - Cristina Carriedo-Scher
- Movil intensive care unit, Gerencia de Urgencias, Emergencias y Transporte Sanitario (GUETS-SESCAM), Castilla la Mancha, España.
| | | | - Carlos Marian-Crespo
- Intensive care unit, Hospital Universitario Guadalajara, SESCAM. Guadalajara, España.
| |
Collapse
|
22
|
Lindow T, Pahlm O, Khoshnood A, Nyman I, Manna D, Engblom H, Lassen AT, Ekelund U. Electrocardiographic changes in the differentiation of ischemic and non-ischemic ST elevation. SCAND CARDIOVASC J 2019; 54:100-107. [PMID: 31885293 DOI: 10.1080/14017431.2019.1705383] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Identification of true STEMI among patients with different ST-elevation etiology may be improved by considering reciprocal ST depression, ST depression in aVR and chest-lead PR depression.
Collapse
Affiliation(s)
- Thomas Lindow
- Department of Clinical Physiology, Växjö Central Hospital, Växjö, Sweden.,Department of Research and Development, Region Kronoberg, Sweden.,Clinical Physiology, Skane University Hospital, Clinical Sciences, Lund University, Lund, Sweden
| | - Olle Pahlm
- Department of Research and Development, Region Kronoberg, Sweden
| | - Ardavan Khoshnood
- Emergency Medicine, Skane University Hospital, Clinical Sciences, Lund University, Lund, Sweden
| | - Ingvar Nyman
- Department of Clinical Physiology, Växjö Central Hospital, Växjö, Sweden
| | - Daniel Manna
- Department of Clinical Physiology, Växjö Central Hospital, Växjö, Sweden
| | - Henrik Engblom
- Department of Research and Development, Region Kronoberg, Sweden
| | | | - Ulf Ekelund
- Emergency Medicine, Skane University Hospital, Clinical Sciences, Lund University, Lund, Sweden
| |
Collapse
|
23
|
Feng L, Li M, Xie W, Zhang A, Lei L, Li X, Gao R, Wu Y. Prehospital and in-hospital delays to care and associated factors in patients with STEMI: an observational study in 101 non-PCI hospitals in China. BMJ Open 2019; 9:e031918. [PMID: 31712344 PMCID: PMC6858215 DOI: 10.1136/bmjopen-2019-031918] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Revised: 09/23/2019] [Accepted: 10/18/2019] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES To describe the prehospital and in-hospital delays to care and factors associated with the delays among patients with ST-segment elevation myocardial infarction (STEMI) in non-percutaneous coronary intervention (PCI) hospitals in China. DESIGN, SETTING AND PARTICIPANTS We analysed data from a large registry-based quality of care improvement trial conducted from 2011 to 2014 among 101 non-PCI hospitals in China. A total of 7312 patients with STEMI were included. Prehospital delay was defined as time from symptom onset to hospital arrival >120 min, first ECG delay as time from arrival to first ECG >10 min, thrombolytic therapy delay as time from first ECG to thrombolytic therapy >10 min and in-hospital delay as time from arrival to thrombolytic therapy >30 min. Logistic regressions with generalised estimating equations were preformed to identify the factors associated with each delay. RESULTS The rates of prehospital delay, first ECG delay, thrombolytic therapy delay and in-hospital delay were 67.1%, 31.4%, 85.8% and 67.8%, respectively. Patients who were female, older than 65 years old, illiterate, farmers, onset during late night and forenoon, had heart rate ≥100 beats/m at admission were more likely and patients who had history of myocardial infarction, hypertension or SBP <90 mm Hg at admission were less likely to have prehospital delay. First ECG delay was more likely to take place in patients arriving on regular hours. Thrombolytic therapy delay rate was lower in patients who had prehospital delay or first ECG delay but higher in those with heart rate ≥100 beats/m at admission. In-hospital delay rate was lower in patients with a history of dyslipidaemia and those who arrived during regular hours. CONCLUSION Chinese patients with STEMI in low medical resource areas suffered severe prehospital and in-hospital delays to care. Future efforts should be made to improve the prehospital delay among vulnerable populations with low socioeconomic status. TRIAL REGISTRATION NUMBER NCT01398228; Post-results.
Collapse
Affiliation(s)
- Lin Feng
- Clinical Research Institute, Peking University First Hospital, Beijing, China
- Peking University Clinical Research Institute, Beijing, China
- The George Institute for Global Health at Peking University Health Science Center, Beijing, China
| | - Min Li
- Clinical Epidemiology and EBM Center, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Disease, Beijing, China
| | - Wuxiang Xie
- Peking University Clinical Research Institute, Beijing, China
| | - Aihua Zhang
- The George Institute for Global Health at Peking University Health Science Center, Beijing, China
| | - Licheng Lei
- The Department of Cardiology, Capital Medical University Affiliated Beijing Shijitan Hospital, Beijing, China
| | - Xian Li
- The George Institute for Global Health at Peking University Health Science Center, Beijing, China
| | - R Gao
- Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China
| | - Yangfeng Wu
- Peking University Clinical Research Institute, Beijing, China
- The George Institute for Global Health at Peking University Health Science Center, Beijing, China
- Epidemiology and Biostatistics, Peking University School of Public Health, Beijing, China
| |
Collapse
|
24
|
Tungsubutra W, Ngoenjan D. Door-to-balloon time and factors associated with delayed door-to-balloon time in ST-segment elevation myocardial infarction at Thailand's largest tertiary referral centre. J Eval Clin Pract 2019; 25:434-440. [PMID: 30417495 DOI: 10.1111/jep.13061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 10/15/2018] [Accepted: 10/16/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To analyse door-to-balloon (DTB) time and to identify factors significantly associated with delayed DTB in patients with ST-segment elevation myocardial infarction (STEMI) at Thailand's largest tertiary referral centre. BACKGROUND DTB time is considered an important measure of performance quality. METHODS This observational study analysed DTB time in patients with STEMI who presented to our institute's emergency department and underwent primary percutaneous coronary intervention (PCI) during June 2008 to May 2011. DTB time greater than 90 minutes was considered delayed. Data were collected to determine which clinical variables were associated with delays. RESULTS One hundred thirty-three patients were included. The mean age of patients was 61.1 ± 13.2 years, and 71.4% were male. Delayed DTB was observed in 70.7% of patients. Median DTB time was 117 (interquartile range [IQR], 86-168), 66 (IQR, 58-84), and 135 (IQR, 112-194) minutes in all patients, in nondelayed patients, and in delayed patients, respectively. Univariate analysis revealed triage to urgent care (P = 0.001) and presentation during on-call hours (P < 0.001) to be significantly associated with delayed DTB. Patients who were triaged to urgent care had a DTB time of 184 vs 105 minutes for triage to the emergency room. Patients who presented during on-call hours had a DTB time of 128 vs 86 minutes for work hour presentation. Presentation during on-call hours was the only significant predictor of DTB time >90 minutes in multivariate analysis (odds ratio [OR], 7.86; 95% confidence interval [CI], 3.39-18.22; P < 0.001). All patients that were triaged to urgent care were delayed; thus, association between urgent care triage and on-call hour service could not be determined. CONCLUSIONS Delayed DTB time occurred in 70.7% of patients. Two key factors that significantly contributed to delayed DTB were patient mistriage to urgent care and presentation during on-call hours.
Collapse
Affiliation(s)
- Wiwun Tungsubutra
- Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Deachart Ngoenjan
- Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| |
Collapse
|
25
|
Yamada T, Takahashi A, Mizuguchi Y, Hashimoto S, Taniguchi N, Nakajima S, Hata T. Impact of shorter door-to-balloon time on prognosis of patients with STEMI-single-center analysis with a large proportion of the patients treated within 30 min. Cardiovasc Interv Ther 2018; 34:97-104. [PMID: 29736670 DOI: 10.1007/s12928-018-0521-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 04/03/2018] [Indexed: 12/14/2022]
Abstract
Several recent studies suggested that the door-to-balloon time (DTBT) for patients with ST-segment elevation myocardial infarction (STEMI) should be as short as possible, despite the existing guideline for STEMI. This study aimed to evaluate the clinical outcomes of the STEMI patient cohort having the highest proportion of patients treated with a DTBT of ≤ 30 min ever reported. We evaluated 527 consecutive patients with STEMI who underwent percutaneous coronary intervention between 2007 and 2015. The mean age was 68.0 ± 12.7 years, and the mean DTBT was 44.4 ± 33.1 min. The patients were classified into four groups according to the DTBT, and the relationship between the DTBT and clinical outcome was investigated. DTBTs were ≤ 30 min in 146 patients (27.7%), 31-60 min in 297 patients (56.4%), 61-90 min in 60 patients (11.4%), and > 90 min in 24 patients (4.6%). In-hospital mortality rates were 0.7, 5.0, 11.7, and 12.5% for DTBTs of ≤ 30, 31-60, 61-90, and > 90 min, respectively. In multivariate analysis, a DTBT ≤ 30 min (odds ratio [OR] 0.11, 95% confidence interval [CI] 0.01-0.91, p = 0.041), shock on arrival (OR 2.74, 95% CI 1.02-7.37, p = 0.046), and blood transfusion (OR 49.60, 95% CI 13.90-177.00, p < 0.001) were the independent predictors of in-hospital mortality. Patients with STEMI treated with a DTBT ≤ 30 min showed significantly better clinical outcomes than those treated with a DTBT > 30 min.
Collapse
Affiliation(s)
- Takeshi Yamada
- Department of Cardiology, Sakurakai Takahashi Hospital, 5-18-1 Oikecho, Suma-ku, Kobe, Hyogo, 654-0026, Japan.
| | - Akihiko Takahashi
- Department of Cardiology, Sakurakai Takahashi Hospital, 5-18-1 Oikecho, Suma-ku, Kobe, Hyogo, 654-0026, Japan
| | - Yukio Mizuguchi
- Department of Cardiology, Sakurakai Takahashi Hospital, 5-18-1 Oikecho, Suma-ku, Kobe, Hyogo, 654-0026, Japan
| | - Sho Hashimoto
- Department of Cardiology, Sakurakai Takahashi Hospital, 5-18-1 Oikecho, Suma-ku, Kobe, Hyogo, 654-0026, Japan
| | - Norimasa Taniguchi
- Department of Cardiology, Sakurakai Takahashi Hospital, 5-18-1 Oikecho, Suma-ku, Kobe, Hyogo, 654-0026, Japan
| | - Shunsuke Nakajima
- Department of Cardiology, Sakurakai Takahashi Hospital, 5-18-1 Oikecho, Suma-ku, Kobe, Hyogo, 654-0026, Japan
| | - Tetsuya Hata
- Department of Cardiology, Sakurakai Takahashi Hospital, 5-18-1 Oikecho, Suma-ku, Kobe, Hyogo, 654-0026, Japan
| |
Collapse
|
26
|
Foo CY, Bonsu KO, Nallamothu BK, Reid CM, Dhippayom T, Reidpath DD, Chaiyakunapruk N. Coronary intervention door-to-balloon time and outcomes in ST-elevation myocardial infarction: a meta-analysis. Heart 2018; 104:1362-1369. [PMID: 29437704 DOI: 10.1136/heartjnl-2017-312517] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Revised: 12/27/2017] [Accepted: 01/05/2018] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE This study aims to determine the relationship between door-to-balloon delay in primary percutaneous coronary intervention and ST-elevation myocardial infarction (MI) outcomes and examine for potential effect modifiers. METHODS We conducted a systematic review and meta-analysis of prospective observational studies that have investigated the relationship of door-to-balloon delay and clinical outcomes. The main outcomes include mortality and heart failure. RESULTS 32 studies involving 299 320 patients contained adequate data for quantitative reporting. Patients with ST-elevation MI who experienced longer (>90 min) door-to-balloon delay had a higher risk of short-term mortality (pooled OR 1.52, 95% CI 1.40 to 1.65) and medium-term to long-term mortality (pooled OR 1.53, 95% CI 1.13 to 2.06). A non-linear time-risk relation was observed (P=0.004 for non-linearity). The association between longer door-to-balloon delay and short-term mortality differed between those presented early and late after symptom onset (Cochran's Q 3.88, P value 0.049) with a stronger relationship among those with shorter prehospital delays. CONCLUSION Longer door-to-balloon delay in primary percutaneous coronary intervention for ST-elevation MI is related to higher risk of adverse outcomes. Prehospital delays modified this effect. The non-linearity of the time-risk relation might explain the lack of population effect despite an improved door-to-balloon time in the USA. CLINICAL TRIAL REGISTRATION PROSPERO (CRD42015026069).
Collapse
Affiliation(s)
- Chee Yoong Foo
- National Clinical Research Centre, Kuala Lumpur, Malaysia.,School of Pharmacy, Monash University Malaysia, Bandar Sunway, Subang Jaya, Selangor, Malaysia.,Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Subang Jaya, Selangor, Malaysia
| | - Kwadwo Osei Bonsu
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Subang Jaya, Selangor, Malaysia.,Pharmacy Department, Accident and Emergency Directorate, Komfo Anokye Teaching Hospital, Kumasi, Ghana.,Department of Pharmacy Practice Faculty of Pharmacy and Pharmaceutical Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Brahmajee K Nallamothu
- VA Health Services Research and Development Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA.,Department of Internal Medicine, Michigan Integrated Center for Health Analytics and Medical Prediction (MiCHAMP), University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Christopher M Reid
- School of Public Health, Curtin University, Perth, Western Australia, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Teerapon Dhippayom
- Faculty of Pharmaceutical Sciences, Naresuan University, Tha Pho, Muang Phitsanulok, Thailand
| | - Daniel D Reidpath
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Subang Jaya, Selangor, Malaysia.,School of Population Health, Curtin University, Perth, Western Australia, Australia.,Molecular, Genetic & Population Health Sciences, University of Edinburgh, Edinburgh, UK.,Asian Centre for Evidence Synthesis in Population, Implementation and Clinical Outcomes (PICO), Health and Well-being Cluster, Global Asia in the 21st Century (GA21) Platform, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
| | - Nathorn Chaiyakunapruk
- School of Pharmacy, Monash University Malaysia, Bandar Sunway, Subang Jaya, Selangor, Malaysia.,Asian Centre for Evidence Synthesis in Population, Implementation and Clinical Outcomes (PICO), Health and Well-being Cluster, Global Asia in the 21st Century (GA21) Platform, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia.,School of Pharmacy, University of Wisconsin, Madison, Wisconsin, USA.,Center of Pharmaceutical Outcomes Research (CPOR), Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand
| |
Collapse
|
27
|
Silveira I, Sousa MJ, Rodrigues P, Brochado B, B Santos R, Trêpa M, Luz A, Silveira J, Albuquerque A, Carvalho H, Torres S. Developments in pre-hospital patient transport in ST-elevation myocardial infarction. Rev Port Cardiol 2017; 36:847-855. [PMID: 29126894 DOI: 10.1016/j.repc.2017.02.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Revised: 02/08/2017] [Accepted: 02/13/2017] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION ST-elevation myocardial infarction (STEMI) is a medical emergency that benefits from rapid access to specialized care. The objective of this study was to describe developments in patient transport via the pre-hospital emergency medical system (EMS) and its impact on clinical outcomes. METHODS We retrospectively studied STEMI patients who underwent primary percutaneous coronary intervention between January 2008 and July 2015. Patients were divided according to type of admission. Total ischemic time (TIT), door-to-balloon time (DBT) and in-hospital and one-year clinical outcomes were assessed for each group. RESULTS A total of 764 patients were included, of whom 33.5% were transported by the EMS and 45.8% by their own means, 13.7% were transferred from another institution and 6.9% were transported by non-EMS ambulance. There was a trend for more frequent recourse to the EMS over the eight-year period. There was a higher percentage of patients with prior myocardial infarction and Killip class III/IV in the EMS group compared to the non-EMS group. Significant differences were seen between groups in reperfusion times, EMS patients having the shortest TIT and DBT (195 vs. 286 min, p<0.001 and 61 vs. 90 min, p<0.001, respectively), but no significant difference in event rates was observed. Patients presenting to the hospital early had higher rates of effective reperfusion and lower in-hospital mortality (6.9% vs. 33.9%, p<0.001). CONCLUSIONS Recourse to the EMS significantly reduced ischemic times. Although this improvement was not directly associated with significant differences in event rates, it was associated with higher rates of effective reperfusion that were reflected in lower in-hospital mortality.
Collapse
Affiliation(s)
- Inês Silveira
- Serviço de Cardiologia, Centro Hospitalar do Porto, Porto, Portugal.
| | - Maria João Sousa
- Serviço de Cardiologia, Centro Hospitalar do Porto, Porto, Portugal
| | | | - Bruno Brochado
- Serviço de Cardiologia, Centro Hospitalar do Porto, Porto, Portugal
| | - Raquel B Santos
- Serviço de Cardiologia, Centro Hospitalar do Porto, Porto, Portugal
| | - Maria Trêpa
- Serviço de Cardiologia, Centro Hospitalar do Porto, Porto, Portugal
| | - André Luz
- Serviço de Cardiologia, Centro Hospitalar do Porto, Porto, Portugal
| | - João Silveira
- Serviço de Cardiologia, Centro Hospitalar do Porto, Porto, Portugal
| | | | | | - Severo Torres
- Serviço de Cardiologia, Centro Hospitalar do Porto, Porto, Portugal
| |
Collapse
|
28
|
Silveira I, Sousa MJ, Rodrigues P, Brochado B, Santos RB, Trêpa M, Luz A, Silveira J, Albuquerque A, Carvalho H, Torres S. Developments in pre-hospital patient transport in ST-elevation myocardial infarction. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2017. [DOI: 10.1016/j.repce.2017.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
|
29
|
Impact of age on short- and long-term mortality of patients with ST-elevation myocardial infarction in the VIENNA STEMI network. Wien Klin Wochenschr 2017; 130:172-181. [DOI: 10.1007/s00508-017-1250-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
|
30
|
Song F, Yu M, Yang J, Xu H, Zhao Y, Li W, Wu D, Wang Z, Wang Q, Gao X, Wang Y, Fu R, Sun Y, Gao R, Yang Y. Symptom-Onset-To-Balloon Time, ST-Segment Resolution and In-Hospital Mortality in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention in China: From China Acute Myocardial Infarction Registry. Am J Cardiol 2016; 118:1334-1339. [PMID: 27666173 DOI: 10.1016/j.amjcard.2016.07.058] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 07/28/2016] [Accepted: 07/28/2016] [Indexed: 11/27/2022]
Abstract
Animal and imaging study evidence favors early reperfusion for acute myocardial infarction. However, in clinical trials, the effect of symptom-onset-to-balloon (S2B) time on clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI) has been inconsistent. Moreover, there are few data regarding the ischemic time in China. A total of 3,877 consecutive patients with STEMI with available S2B time undergoing pPCI from January 2013 to September 2014 at 108 hospitals that participated in the China Acute Myocardial Infarction registry were included and stratified into 3 S2B groups: <6 hours, 6 to 12 hours, >12 hours S2B time was tested in multivariate logistic regression analyses as an independent risk factor of mortality (primary outcome), major adverse cardiovascular and cerebrovascular events (MACCE), and impaired myocardial perfusion (secondary outcomes). The median S2B time was 5.5 (3.75 to 8.50) hours. Longer S2B time was associated with higher in-hospital mortality (<6 hours: 2.7%; 6 to 12 hours: 3.4%; >12 hours: 4.9%; p = 0.047) and ST-segment resolution <50% (<6 hours: 16.7%; 6 to 12 hours: 19.2%; >12 hours: 24.3%; p = 0.002) but not MACCE. In multivariate-adjusted analysis, S2B >12 hours remained associated with ST-segment resolution <50% (odds ratio 1.53, 95% confidence interval 1.16 to 2.01, p = 0.002) but not with in-hospital mortality (odds ratio 1.673, 95% confidence interval 0.95 to 2.94, p = 0.073). In conclusion, median S2B time in patients with STEMI undergoing pPCI was longer than that in registry studies from other countries. Longer S2B time was associated with impaired myocardial perfusion but not with in-hospital mortality or MACCE.
Collapse
|
31
|
Kim HK, Jeong MH, Ahn Y, Chae SC, Kim YJ, Hur SH, Seong IW, Hong TJ, Choi DH, Cho MC, Kim CJ, Seung KB, Jang YS, Rha SW, Bae JH, Kim SS, Park SJ. Relationship between time to treatment and mortality among patients undergoing primary percutaneous coronary intervention according to Korea Acute Myocardial Infarction Registry. J Cardiol 2016; 69:377-382. [PMID: 27720323 DOI: 10.1016/j.jjcc.2016.09.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 09/04/2016] [Accepted: 09/13/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND Despite large reductions in door-to-balloon times over the period, several studies from regional and national data showed that annual mortality rates were not decreased among patients who underwent primary percutaneous coronary intervention (PCI). However, these studies mostly focused on door-to-balloon time, and there was no consideration of total ischemic time in a trend of mortality. The aim of this study was to assess the annual trend between time to treatment and 1-month mortality among patients undergoing primary PCI. METHODS AND RESULTS The study population consisted of 8040 patients who underwent primary PCI at hospitals participating in the nationwide prospective Korea Acute Myocardial Infarction Registry (KAMIR) between January 2008 and December 2011. The primary end point of this study was 1-month all-cause mortality, and time to treatment (door-to-balloon time, symptom-to-balloon time). One-month death occurred in 452 patients (5.6%) from 2008 to 2011. Additional reductions in door-to-balloon time were not translated into parallel reductions in mortality rate and total ischemic time. After adjustment using clinical risk, shorter total ischemic time was an independent predictor of 1-month mortality [adjusted odds ratio (OR) 0.78, 95% confidential interval (CI) 0.62-0.99, p=0.04]. Total ischemic time could be reduced by using emergency medical services. CONCLUSION Despite improvements in door-to-balloon time, no parallel reductions in mortality rate and total ischemic time were observed. Total ischemic time was associated with mortality. The present study suggests that additional efforts are needed to shorten total ischemic time including patient and pre-hospital systemic delay for better prognosis after primary PCI.
Collapse
Affiliation(s)
- Hyun Kuk Kim
- Chosun University Hospital, Gwangju, Republic of Korea
| | - Myung Ho Jeong
- Chonnam National University Hospital, Gwangju, Republic of Korea.
| | - Youngkeun Ahn
- Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Shung Chull Chae
- Kyungpook National University Hosptial, Daegu, Republic of Korea
| | - Young Jo Kim
- Yeungnam University Hospital, Daegu, Republic of Korea
| | - Seung Ho Hur
- Keimyung University Hospital, Daegu, Republic of Korea
| | - In Whan Seong
- Chungnam National University Hospital, Daejon, Republic of Korea
| | - Taek Jong Hong
- Busan National University Hospital, Busan, Republic of Korea
| | - Dong Hoon Choi
- Yonsei University Severans Hospital, Seoul, Republic of Korea
| | - Myeong Chan Cho
- Chungbuk National University Hospital, Cheonju, Republic of Korea
| | - Chong Jin Kim
- Kyunghee University Hospital, Seoul, Republic of Korea
| | - Ki Bae Seung
- Catholic University Hospital, Seoul, Republic of Korea
| | - Yang Soo Jang
- Yonsei University Severans Hospital, Seoul, Republic of Korea
| | | | - Jang Ho Bae
- Konyang University Hospital, Seoul, Republic of Korea
| | - Sung Soo Kim
- Kwangju Christian Hospital, Gwangju, Republic of Korea
| | | | | |
Collapse
|
32
|
Sardar MR, Dawn Abbott J. Myocardial salvage and mortality in STEMI: A race against ischemic time. Catheter Cardiovasc Interv 2016; 87:1201-2. [PMID: 27310751 DOI: 10.1002/ccd.26599] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 05/02/2016] [Indexed: 11/07/2022]
Abstract
Total ischemic time (IT) and door-to-balloon time (DBT) are two important measures in patients with ST segment elevation myocardial infarction (STEMI). IT is a better predictor of cardiovascular outcomes than DTB, including infarct size and mortality, in STEMI patients treated with primary percutaneous coronary intervention. IT should be adopted as a standard metric to measure quality of care in STEMI, and will help to promote improvements to our health care delivery system.
Collapse
Affiliation(s)
- M Rizwan Sardar
- Brown Medical School, Division of Cardiology, Rhode Island Hospital, Providence, Rhode Island
| | - J Dawn Abbott
- Brown Medical School, Division of Cardiology, Rhode Island Hospital, Providence, Rhode Island
| |
Collapse
|