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Kamal A, Zaki A, Abdelaaty A, Madkour M. Management of ST-segment elevation myocardial infarction in comparison to European society of cardiology guidelines in Alexandria University Hospitals, Egypt. Egypt Heart J 2023; 75:5. [PMID: 36680659 PMCID: PMC9867789 DOI: 10.1186/s43044-023-00332-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 01/16/2023] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND For patients with ST-elevation myocardial infarction (STEMI), early reperfusion with primary percutaneous coronary intervention (PPCI) or thrombolytic treatment is essential to prevent major adverse cardiac events. The aim of the study is to compare the current status of managing STEMI patients at **** with European Society of Cardiology guidelines recommendations. Prospective cohort of all patients presenting with ST-elevation myocardial infarction (STEMI) between March 2020 and February 2021 in Alexandria University hospitals. Reporting patterns, causes of delay, and reperfusion status for all STEMI patients were noted. MACE: (Mortality, Re-infarction, Stroke, or Heart failure) was reported and compared among different management strategies. RESULTS The study was conducted over one year on 436 patients, 280 (64.2%) of them underwent PPCI, 32 (7.3%) received thrombolysis, and 124 (28.5%) had a conservative strategy. Patients' mean age was 55.2 years, 72.2% were smokers and 80.9% were men. Family history was positive in 14.2% of patients, 33.5% had diabetes, 7.3% had renal impairment, and 41.5% had hypertension. The median pre-hospital waiting time was 360 min; the mean pre-hospital waiting time was 629.0 ± 796.7 min. The median Emergency Room waiting time was 48.24 ± 89.30 min. The median time from CCU admission to wire crossing was 40.0 min with a mean value 53.86 ± 49.0 min. The mean ischemia duration was 408 min, while the total ischemic time was 372 min. All patients who presented within 12 h received reperfusion therapy either a PPCI or thrombolysis at a rate of 71.5%, with 35.0% of those patients achieving prompt reperfusion in accordance with ESC guidelines. The PPCI group mortality rate was 2.9%, in comparison to 12.9% in the conservative group, which was statistically significant (P < 0.001). Overall in-hospital mortality was 5.5%, and total MACE was 27.3%. A statistically significant difference was observed between the three management groups as regards MACE rate, being 15%, 28.1%, and 54.8% in PPCI, thrombolysis, and conservative groups, respectively. CONCLUSIONS Despite financial and technical constraints, appropriate, timely reperfusion was near to achieving the ESC guidelines for the management of STEMI. The most common reperfusion strategy was PPCI, with an in-hospital death rate of less than 5% in the PPCI group. There was a concern about the increase in the total ischemia time due to some financial and technical constraints.
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Affiliation(s)
- Amr Kamal
- grid.7155.60000 0001 2260 6941Cardiology and Angiology Department, Faculty of Medicine, Alexandria University, Champollion Street, Azareeta, Alexandria Egypt
| | - Amr Zaki
- grid.7155.60000 0001 2260 6941Cardiology and Angiology Department, Faculty of Medicine, Alexandria University, Champollion Street, Azareeta, Alexandria Egypt
| | - Ahmed Abdelaaty
- grid.7155.60000 0001 2260 6941Cardiology and Angiology Department, Faculty of Medicine, Alexandria University, Champollion Street, Azareeta, Alexandria Egypt
| | - Moustafa Madkour
- grid.7155.60000 0001 2260 6941Cardiology and Angiology Department, Faculty of Medicine, Alexandria University, Champollion Street, Azareeta, Alexandria Egypt
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Temporal Trends in Reperfusion Delivery and Clinical Outcomes Following Implementation of a Regional STEMI Protocol – a 12 Year Perspective. CJC Open 2022; 5:181-190. [PMID: 37013074 PMCID: PMC10066451 DOI: 10.1016/j.cjco.2022.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 11/14/2022] [Indexed: 12/15/2022] Open
Abstract
Background The Vancouver Coastal Health (VCH) ST-elevation myocardial infarction (STEMI) program aimed to increase access to primary percutaneous coronary intervention (PPCI) and reduce first-medical-contact-to-device times (FMC-DTs). We evaluated the long-term program impact on PPCI access and FMC-DT, and overall and reperfusion-specific in-hospital mortality. Methods We analyzed all VCH STEMI patients between June 2007 and November 2019. The primary outcome was the proportion of patients receiving PPCI over 4 program implementation phases over 12 years. We also evaluated overall changes in median FMC-DT and the proportion of patients achieving guideline-mandated FMC-DT, in addition to overall and reperfusion-specific in-hospital mortality. Results A total of 3138 of 4305 VCH STEMI patients were treated with PPCI. PPCI rates increased from 40.2% to 78.7% from 2007 to 2019 (P < 0.001). From phase 1 to 4, median FMC-DT improved from 118 to 93 minutes (percutaneous coronary intervention [PCI]-capable hospitals, P < 0.001) and from 174 to 118 minutes (non-PCI-capable hospitals, P < 0.001), with a concomitant increase in those achieving guideline-mandated FMC-DT (35.5% to 66.1%, P < 0.001). Overall in-hospital mortality was 9.0% (P = 0.20 across phases), with mortality differing significantly by reperfusion strategy (4.0% fibrinolysis, 5.7% PPCI, 30.6% no reperfusion therapy, P < 0.001). Mortality significantly decreased from phase 1 to phase 4 at non-PCI-capable centres (9.6% to 3.9%, P = 0.022) but not at PCI-capable centres (8.7% vs 9.9%, P = 0.27). Conclusions A regional STEMI program increased the proportion of patients who received PPCI and improved reperfusion times over 12 years. Although no statistically significant decrease occurred in overall regional mortality incidence, mortality incidence was decreased for patients presenting to non-PCI-capable centres.
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Amon J, Wong GC, Lee T, Singer J, Cairns J, Shavadia JS, Granger C, Gin K, Wang TY, van Diepen S, Fordyce CB. Incidence and Predictors of Adverse Events Among Initially Stable ST-Elevation Myocardial Infarction Patients Following Primary Percutaneous Coronary Intervention. J Am Heart Assoc 2022; 11:e025572. [PMID: 36056738 PMCID: PMC9496426 DOI: 10.1161/jaha.122.025572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background Cardiac intensive care units were originally created in the prerevascularization era for the early recognition of ventricular arrhythmias following a myocardial infarction. Many patients with stable ST‐segment–elevation myocardial infarction (STEMI) are still routinely triaged to cardiac intensive care units after a primary percutaneous coronary intervention (pPCI), independent of clinical risk or the provision of critical care therapies. The aim of this study was to determine factors associated with in‐hospital adverse events in a hemodynamically stable, postreperfusion population of patients with STEMI. Methods and Results Between April 2012 and November 2019, 2101 consecutive patients with STEMI who received pPCI in the Vancouver Coastal Health Authority were evaluated. Patients were stratified into those with and without subsequent adverse events, which were defined as cardiogenic shock, in‐hospital cardiac arrest, stroke, re‐infarction, and death. Multivariable logistic regression models were used to determine predictors of adverse events. After excluding patients presenting with cardiac arrest, cardiogenic shock, or heart failure, the final analysis cohort comprised 1770 stable patients with STEMI who had received pPCI. A total of 94 (5.3%) patients developed at least one adverse event: cardiogenic shock 55 (3.1%), in‐hospital cardiac arrest 42 (2.4%), death 28 (1.6%), stroke 21 (1.2%), and re‐infarction 5 (0.3%). Univariable predictors of adverse events were older age, female sex, prior stroke, chronic kidney disease, and atrial fibrillation. There was no significant difference in reperfusion times between those with and without adverse events. Following multivariable adjustment, moderate to severe chronic kidney disease (creatinine clearance <44 mL/min; 13% of cohort) was associated with adverse events (odds ratio 2.24 [95% CI, 1.12–4.48]) independent of reperfusion time, age, sex, smoking status, hypertension, diabetes, and prior myocardial infarction/PCI/coronary artery bypass grafting. Conclusions Only 1 in 20 initially stable patients with STEMI receiving pPCI developed an in‐hospital adverse event. Moderate to severe chronic kidney disease independently predicted the risk of future adverse events. These results indicate that the majority of patients with STEMI who receive pPCI may not require routine admission to a cardiac intensive care unit following reperfusion.
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Affiliation(s)
- Jaihoon Amon
- Division of Cardiology University of Saskatchewan Saskatoon Saskatchewan Canada
| | - Graham C Wong
- Division of Cardiology University of British Columbia and Vancouver General Hospital Vancouver British Columbia Canada.,Centre for Cardiovascular Innovation University of British Columbia Vancouver British Columbia Canada
| | - Terry Lee
- Centre for Health Evaluation and Outcome Sciences Vancouver British Columbia Canada.,School of Population and Public Health University of British Columbia Vancouver British Columbia Canada
| | - Joel Singer
- Centre for Health Evaluation and Outcome Sciences Vancouver British Columbia Canada.,School of Population and Public Health University of British Columbia Vancouver British Columbia Canada
| | - John Cairns
- Division of Cardiology University of British Columbia and Vancouver General Hospital Vancouver British Columbia Canada.,Centre for Cardiovascular Innovation University of British Columbia Vancouver British Columbia Canada
| | - Jay S Shavadia
- Division of Cardiology University of Saskatchewan Saskatoon Saskatchewan Canada
| | - Christopher Granger
- Duke Clinical Research Institute Duke University School of Medicine Durham NC
| | - Kenneth Gin
- Division of Cardiology University of British Columbia and Vancouver General Hospital Vancouver British Columbia Canada.,Centre for Cardiovascular Innovation University of British Columbia Vancouver British Columbia Canada
| | - Tracy Y Wang
- Duke Clinical Research Institute Duke University School of Medicine Durham NC
| | - Sean van Diepen
- Division of Cardiology, Department of Medicine and Department of Critical Care Medicine University of Alberta Edmonton Alberta Canada
| | - Christopher B Fordyce
- Division of Cardiology University of British Columbia and Vancouver General Hospital Vancouver British Columbia Canada.,Centre for Cardiovascular Innovation University of British Columbia Vancouver British Columbia Canada.,Centre for Health Evaluation and Outcome Sciences Vancouver British Columbia Canada
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Malhi N, Moghaddam N, Hosseini F, Singer J, Lee T, Turgeon RD, Wong GC, Fordyce CB. Care and Outcomes of ST-Segment Elevation Myocardial Infarction Across Multiple COVID-19 Waves. Can J Cardiol 2022; 38:783-791. [PMID: 35151778 PMCID: PMC8830145 DOI: 10.1016/j.cjca.2022.01.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 01/10/2022] [Accepted: 01/31/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND There are concerns of delays in ST-segment elevation myocardial infarction (STEMI) care during the COVID-19 pandemic. It is unclear whether the care and outcomes of STEMI patients differ between COVID-19 waves and compared with historical periods. METHODS Consecutive patients in the Vancouver Coastal Health Authority STEMI database were included to compare care during 3 distinct waves of the COVID-19 pandemic (9 months; March 2020 to January 2021) with an historical non-COVID-19 cohort. We compared STEMI incidence, baseline characteristics, and outcomes between groups. We also examined time from first medical contact (FMC) to reperfusion, symptom to FMC, and FMC to STEMI diagnosis, as well as predictors of delays. RESULTS The incidence of STEMI was similar during COVID-19 (n = 305; mean 0.93/day) and before COVID-19 (n = 949; 0.97/day; P = 0.80). The COVID-19 cohort showed significant delay in FMC-to-reperfusion (median 116 min vs 102 min; P < 0.001) and FMC-to-STEMI diagnosis (median 17 mins vs 11 min; P < 0.001). Delays in FMC-to-device times worsened across the 3 COVID-19 waves (FMC-to-device time ≤ 90 min in wave 1: 32.9%; in wave 2: 25.6%; in wave 3: 16.3%; P = 0.045 [47.5% before COVID-19; P < 0.001]). There were no significant predictors of delay were unique to the COVID-19 cohort. CONCLUSIONS This study demonstrates delays in reperfusion during the COVID-19 pandemic compared with the historical control, with delays increasing during subsequent waves within the pandemic. It is critical to further understand these care gaps to improve STEMI care for future waves of the current and future pandemics.
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Affiliation(s)
- Navraj Malhi
- Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nima Moghaddam
- Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Farshad Hosseini
- Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Joel Singer
- Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada,Centre for Health Evaluation and Outcomes Sciences, Vancouver, British Columbia, Canada
| | - Terry Lee
- Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada,Centre for Health Evaluation and Outcomes Sciences, Vancouver, British Columbia, Canada
| | - Ricky D. Turgeon
- Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada,Centre for Health Evaluation and Outcomes Sciences, Vancouver, British Columbia, Canada,Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Graham C. Wong
- Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Christopher B. Fordyce
- Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada,Centre for Health Evaluation and Outcomes Sciences, Vancouver, British Columbia, Canada,Corresponding author: Dr Christopher B. Fordyce, Level 9, 2775 Laurel Street, Vancouver, British Columbia V5Z1M9, Canada. Tel.: +1-604-875-5735; fax: +1-604-875-5736
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5
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Mackay MH, Chruscicki A, Christenson J, Cairns JA, Lee T, Turgeon R, Tallon JM, Helmer J, Singer J, Wong GC, Fordyce CB. Association of pre‐hospital time intervals and clinical outcomes in ST‐elevation myocardial infarction patients. J Am Coll Emerg Physicians Open 2022; 3:e12764. [PMID: 35702143 PMCID: PMC9174874 DOI: 10.1002/emp2.12764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/07/2022] [Accepted: 05/20/2022] [Indexed: 11/30/2022] Open
Abstract
Study Objectives Timely coronary reperfusion is critical for favorable outcomes after ST‐elevation myocardial infarction (STEMI). A substantial proportion of the total ischemic time is patient related, occurring before first medical contact (FMC). We aimed to expand the limited current understanding of the associations between prehospital intervals and clinical outcomes. Methods We conducted a retrospective analysis of consecutive STEMI patients who underwent primary percutaneous coronary intervention (pPCI) (January 2009–March 2016) and assessed the associations between prehospital intervals and the incidence of new heart failure, cardiogenic shock, and hospital length of stay (LOS), adjusting for important clinical variables. Results A total of 773 patients (77% men, median age 65 years) met eligibility criteria. The median pre‐911 activation interval was 29 minutes (interquartile range: 11, 89); the median 911 call to FMC interval was 12 minutes (interquartile range: 9, 15). In multivariable analysis, there was a V‐shaped relationship between the pre‐911 activation interval and outcomes: a lower likelihood of new heart failure (odds ratio [OR] 0.51; 95% confidence interval [CI]: 0.30, 0.87), cardiogenic shock (OR 0.40; 95% CI: 0.21, 0.75) and prolonged LOS (OR 0.24; 95% CI: 0.14, 0.42) for midrange intervals (11–88 minutes) when compared to the early (< 11‐minute) interval. There was no statistically significant relationship between total pre‐FMC time and FMC to device activation time. Conclusions Among ambulance‐transported STEMI patients receiving pPCI, the shortest and longest pre‐911 activation time intervals were associated with poorer outcomes. However, variation in post‐FMC interval alone was not associated with outcomes, suggesting that interventions to reduce pre‐FMC intervals must be prioritized.
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Affiliation(s)
- Martha H. Mackay
- School of Nursing University of British Columbia Vancouver British Columbia Canada
- Centre for Health Evaluation and Outcome Sciences University of British Columbia, St. Paul's Hospital Vancouver British Columbia Canada
- Providence Research Vancouver British Columbia Canada
| | - Adam Chruscicki
- Division of Internal Medicine Vancouver Coastal Health Diamond Health Care Centre Vancouver British Columbia Canada
| | - Jim Christenson
- Department of Emergency Medicine University of British Columbia Diamond Health Care Centre Vancouver British Columbia Canada
- Centre for Health Evaluation and Outcome Sciences University of British Columbia, St. Paul's Hospital Vancouver British Columbia Canada
- Providence Research Vancouver British Columbia Canada
- British Columbia Resuscitation Research Collaborative Vancouver British Columbia Canada
| | - John A. Cairns
- Division of Cardiology University of British Columbia Diamond Health Care Centre Vancouver British Columbia Canada
| | - Terry Lee
- Centre for Health Evaluation and Outcome Sciences University of British Columbia, St. Paul's Hospital Vancouver British Columbia Canada
| | - Ricky Turgeon
- St. Paul's Hospital Vancouver British Columbia Canada
| | - John M. Tallon
- Department of Emergency Medicine University of British Columbia Diamond Health Care Centre Vancouver British Columbia Canada
- British Columbia Emergency Health Services Vancouver British Columbia Canada
| | - Jennifer Helmer
- British Columbia Emergency Health Services Vancouver British Columbia Canada
| | - Joel Singer
- Centre for Health Evaluation and Outcome Sciences University of British Columbia, St. Paul's Hospital Vancouver British Columbia Canada
- School of Population and Public Health Faculty of Medicine University of British Columbia Vancouver British Columbia Canada
| | - Graham C. Wong
- Division of Cardiology University of British Columbia Diamond Health Care Centre Vancouver British Columbia Canada
| | - Christopher B. Fordyce
- Division of Cardiology University of British Columbia Diamond Health Care Centre Vancouver British Columbia Canada
- Centre for Health Evaluation and Outcome Sciences University of British Columbia, St. Paul's Hospital Vancouver British Columbia Canada
- British Columbia Resuscitation Research Collaborative Vancouver British Columbia Canada
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6
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De Rosa M, Zimarino M. Analysis of disparity in treatment delays is a major determinant of healthcare quality improvement. J Cardiovasc Med (Hagerstown) 2022; 23:165-166. [PMID: 35103638 DOI: 10.2459/jcm.0000000000001289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Matteo De Rosa
- Institute of Cardiology, University 'G. d'Annunzio' Chieti-Pescara
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7
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Thibert MJ, Fordyce CB, Cairns JA, Turgeon RD, Mackay M, Lee T, Tocher W, Singer J, Perry-Arnesen M, Wong GC. Access-Site vs Non-Access-Site Major Bleeding and In-Hospital Outcomes Among STEMI Patients Receiving Primary PCI. CJC Open 2021; 3:864-871. [PMID: 34401693 PMCID: PMC8347846 DOI: 10.1016/j.cjco.2021.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 02/08/2021] [Indexed: 10/27/2022] Open
Abstract
Background Major bleeding (MB) is an independent predictor of mortality among ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (pPCI). Prevention of access-site MB has received significant attention. However, limited data have been obtained on the influence of access-site MB vs non-access-site MB and association with subsequent adverse in-hospital outcomes in the STEMI population undergoing pPCI. Methods We identified 1494 STEMI patients who underwent pPCI between 2012 and 2018. Unadjusted and adjusted differences among patients with no MB, access-site MB, non-access-site MB, and in-hospital clinical outcomes were assessed. The use of bleeding-avoidance strategies and their effects on MB were also evaluated. Results MB occurred in 121 (8.1%) patients. Access-site MB occurred in 34 (2.3%) patients, and non-access-site MB occurred in 87 (5.8%). The median reduction in hemoglobin was 31 g/L (interquartile range: 19-43) with access-site MB, and 44 g/L (interquartile range: 29-62) with non-access-site MB. After multivariable adjustment, non-access-site MB was independently associated with in-hospital death (adjusted odds ratio [aOR] 4.21; 95% confidence interval [CI] 2.04-8.68), cardiogenic shock (aOR 10.91; 95% CI 5.67-20.98), and cardiac arrest (aOR 5.63; 95% CI 2.88-11.01). Conversely, access-site MB was not associated with adverse in-hospital outcomes. Bleeding-avoidance strategies were used frequently; however, after multivariable adjustment, no single bleeding-avoidance strategy was significantly associated with reduced MB. Conclusions In STEMI patients undergoing pPCI, non-access-site MB was independently associated with adverse in-hospital outcomes, whereas access-site MB was not. Additional study of strategies to reduce the incidence and impact of non-access-site MB appears to be warranted.
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Affiliation(s)
- Michael J Thibert
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - Christopher B Fordyce
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - John A Cairns
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ricky D Turgeon
- Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada.,University of British Columbia Faculty of Pharmaceutical Sciences, Vancouver, British Columbia, Canada.,Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada
| | - Martha Mackay
- Providence Health Care Research Institute, University of British Columbia, Vancouver, British Columbia, Canada.,St Paul's Hospital Heart Centre, Vancouver, British Columbia, Canada.,University of British Columbia School of Nursing, Vancouver, British Columbia, Canada
| | - Terry Lee
- Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Wendy Tocher
- Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada
| | - Joel Singer
- Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Michele Perry-Arnesen
- Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada.,Burnaby Hospital, Fraser Health Authority, Burnaby, British Columbia, Canada
| | - Graham C Wong
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada
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8
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Rayner-Hartley E, Wong GC, Fayowski C, Cairns JA, Singer J, Lee T, Sedlak T, Humphries KH, Perry-Arnesen M, Mackay M, Fordyce CB. Impact of regionalizing ST-elevation myocardial infarction care on sex differences in reperfusion times and clinical outcomes. Clin Cardiol 2021; 44:1113-1119. [PMID: 34101211 PMCID: PMC8364721 DOI: 10.1002/clc.23658] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 05/04/2021] [Accepted: 05/18/2021] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Women with ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention historically experience worse in-hospital outcomes compared to men. HYPOTHESIS Implementation of a regional STEMI system will reduce care gaps in reperfusion times and in-hospital outcomes between women and men. METHODS 1928 patients (413 women, 21.4%) presented with an acute STEMI between June 2007 and March 2016. The population was divided into an early cohort (n = 728 patients, 2007-May 2011), and a late cohort (n = 1200 patients, June 2011-2016). The primary endpoints evaluated were reperfusion times and in-hospital outcomes. RESULTS Compared to men, women experienced significant delays in first medical contact (FMC) to arrival at the emergency room (26.0 vs. 22.0 min, p < 0.001) and FMC-to-device (109 vs. 101 min p = 0.001). Women had higher incidences of post-PCI heart failure and death compared to men (p < 0.05). Following multivariable adjustment, no mortality difference was observed for women versus men (adjusted OR; 0.82; 95% confidence interval [CI], 0.51-1.34; p = 0.433) or for early versus late cohorts (adjusted OR; 1.04; 95% CI, 0.68-1.60; p = 0.856). CONCLUSION Following STEMI regionalization, women continued to experience significantly longer reperfusion times, although there was no difference in adjusted mortality. These results highlight the ongoing disparity of STEMI care between women and men, and suggest that regionalization alone is insufficient to close sex-based care gaps.
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Affiliation(s)
- Erin Rayner-Hartley
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.,Royal Columbian Hospital, Division of Cardiology, Fraser Health Authority, Surrey, British Columbia, Canada
| | - Graham C Wong
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.,Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada
| | - Cassandra Fayowski
- Division of General Internal Medicine, Western University, London, Ontario, Canada
| | - John A Cairns
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.,Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada
| | - Joel Singer
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Health Evaluation and Outcome Sciences (CHEOS), Providence Health Care Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Terry Lee
- Centre for Health Evaluation and Outcome Sciences (CHEOS), Providence Health Care Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tara Sedlak
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.,Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada.,Centre for Health Evaluation and Outcome Sciences (CHEOS), Providence Health Care Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Karin H Humphries
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Health Evaluation and Outcome Sciences (CHEOS), Providence Health Care Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Michele Perry-Arnesen
- Royal Columbian Hospital, Division of Cardiology, Fraser Health Authority, Surrey, British Columbia, Canada
| | - Martha Mackay
- Centre for Health Evaluation and Outcome Sciences (CHEOS), Providence Health Care Research Institute, University of British Columbia, Vancouver, British Columbia, Canada.,School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| | - Christopher B Fordyce
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.,Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada.,Centre for Health Evaluation and Outcome Sciences (CHEOS), Providence Health Care Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
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