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Zeng X, Chen L, Jou E, Chandra A, Ma G, Zheng X, Tu J, Liang J, Xie S, Liu J, Roldan FJ, Li Z, Pan W, Li W. Reducing door-to-wire time for ST-elevation myocardial infarction patients undergoing primary percutaneous coronary intervention by multidisciplinary collaboration: An observational study. Medicine (Baltimore) 2024; 103:e39297. [PMID: 39213199 PMCID: PMC11365621 DOI: 10.1097/md.0000000000039297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2024] [Revised: 06/28/2024] [Accepted: 07/23/2024] [Indexed: 09/04/2024] Open
Abstract
The aim of this study is to reduce door-to-wire time for ST-elevation myocardial infarction patients undergoing primary percutaneous coronary intervention through multidisciplinary collaboration. Patients over the age of 18who visited the Foshan Sanshui District People's Hospital between 2018 and 2019 and were diagnosed with STEMI were included in this study. Analyses were performed with patients segregated into a pre-intervention interim period (2018) and a post-intervention period (2019) based on the date of admission. Intervention measures for reducing door to wire time were fully implemented towards the end of the interim period. There were no significant differences in the baseline characteristics of the 2 groups. Median door to puncture time was reduced from 57.5 minutes in the interim period to 46.0 minutes (P < .001) in the post-intervention period. Similarly, median door to wire time was shortened from 88.0 minutes to 63.5 minutes (P < .001). During the interim period, 24% of patients had a door to wire time of <60 minutes, compared to 40.67% of patients in the post-intervention period (P = .002). Multidisciplinary collaboration is an important strategy to reduce door to wire time for patients with STEMI, and may be implemented in suitable centers to improve patient care.
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Affiliation(s)
- Xiaoru Zeng
- Internal Medicine-Cardiovascular Department, Foshan Sanshui District People’s Hospital, Foshan, Guangdong, China
| | - Ling Chen
- Internal Medicine-Cardiovascular Department, Foshan Sanshui District People’s Hospital, Foshan, Guangdong, China
| | - Eric Jou
- Medical Sciences Division, Oxford University Hospitals, University of Oxford, Oxford, United Kingdom
- Kellogg College, University of Oxford, Oxford, United Kingdom
| | - Ayush Chandra
- Department of Clinical Medicine, Tianjin Medical University, Tianjin, China
| | - Guanglong Ma
- Internal Medicine-Cardiovascular Department, Foshan Sanshui District People’s Hospital, Foshan, Guangdong, China
| | - Xiaodong Zheng
- Internal Medicine-Cardiovascular Department, Foshan Sanshui District People’s Hospital, Foshan, Guangdong, China
| | - Junrong Tu
- Internal Medicine-Cardiovascular Department, Foshan Sanshui District People’s Hospital, Foshan, Guangdong, China
| | - Jianguang Liang
- Internal Medicine-Cardiovascular Department, Foshan Sanshui District People’s Hospital, Foshan, Guangdong, China
| | - Shengde Xie
- Department of Emergency Medicine, Foshan Sanshui District People’s Hospital, Foshan, Guangdong, China
| | - Jiachao Liu
- Internal Medicine-Cardiovascular Department, Foshan Sanshui District People’s Hospital, Foshan, Guangdong, China
| | | | - Zhenzhang Li
- College of Mathematics and Systems Science, Guangdong Polytechnic Normal University, Guangzhou, China
- School of Basic Medical Sciences, Guangzhou Medical University, Guangzhou, China
| | - Wanling Pan
- Internal Medicine-Cardiovascular Department, Foshan Sanshui District People’s Hospital, Foshan, Guangdong, China
- Department of Nursing, Foshan Sanshui District People’s Hospital, Foshan, Guangdong Province, China
| | - Wanquan Li
- Internal Medicine-Cardiovascular Department, Foshan Sanshui District People’s Hospital, Foshan, Guangdong, China
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Cartanya-Bonvehi J, Pericas-Vila A, Subirana I, García-García C, Tizón-Marcos H, Elosua R. Effectiveness of STEMI networks with out-of-hospital triage: a systematic review and meta-analysis. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2024:S1885-5857(24)00245-7. [PMID: 39121993 DOI: 10.1016/j.rec.2024.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Accepted: 07/23/2024] [Indexed: 08/12/2024]
Abstract
INTRODUCTION AND OBJECTIVES Primary percutaneous coronary intervention (pPCI) is recommended for ST elevation myocardial infarction (STEMI). Countries have designed various STEMI network models to optimize out-of-hospital triage, timely treatment, and patient outcomes. The aim of this study was to evaluate the effectiveness of STEMI network implementation including out-of-hospital triage in improving STEMI case-fatality and long-term mortality, and its effect on the proportion of patients presenting with heart failure, their ischemia time, and time to pPCI. METHODS Systematic review and meta-analysis. Searches of PubMed, Scopus, and Web of Science databases covering January 2000 to December 2023, study selection, and data extraction were completed by 3 independent reviewers. RESULTS A total of 32 articles were selected. STEMI network implementation with out-of-hospital triage was associated with reductions of 35% in case-fatality (95%CI, -23% to -45%), 27% in long-term mortality (95%CI, -22% to -32%), and in the proportion of patients with Killip III-IV at admission, ischemia, time and time to pPCI (-17%, 95%CI, -35% +6%; -19%, 95%CI, -6% to -31%; -33%, 95%CI, -16% to -47%, respectively). Networks based on emergency transport systems and those involving the entire health system, including primary care centers and hospitals without pPCI capabilities, showed similar effectiveness. Greater effectiveness was observed in urban vs rural areas and high-income vs middle- and low-income countries. CONCLUSIONS The implementation of out-of-hospital triage-based STEMI networks is effective in reducing STEMI case-fatality and long-term mortality, independently of the geographic and socioeconomic conditions of the region. Participation of the emergency transport system is the key element of successful networks.
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Affiliation(s)
- Joan Cartanya-Bonvehi
- Centro de Atención Primaria Vic Nord, Instituto Catalán de la Salud, Vic, Barcelona, Spain; Departamento de Medicina, Facultad de Medicina, Universidad de Vic-Universidad Central de Cataluña, Vic, Barcelona, Spain; Instituto de Investigación e Innovación en Ciencias de la Vida y de la Salud en la Cataluña Central (IRIS-CC), Vic, Barcelona, Spain
| | - Anna Pericas-Vila
- Departamento de Medicina, Facultad de Medicina, Universidad de Vic-Universidad Central de Cataluña, Vic, Barcelona, Spain
| | - Isaac Subirana
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Hospital del Mar Research Institute, Barcelona, Spain
| | - Cosme García-García
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Helena Tizón-Marcos
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Hospital del Mar Research Institute, Barcelona, Spain; Servicio de Cardiología, Hospital del Mar, Barcelona, Spain
| | - Roberto Elosua
- Departamento de Medicina, Facultad de Medicina, Universidad de Vic-Universidad Central de Cataluña, Vic, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Hospital del Mar Research Institute, Barcelona, Spain.
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Imhof S, Hochadel M, Konstantinides S, Voigtländer T, Schmitt C, Nowak B, Rassaf T, Senges J, Münzel T, Giannitsis E, Breuckmann F. Cardiac, possible cardiac, and likely non-cardiac origin of chest pain : A hitherto underestimated parameter in German chest pain units. Herz 2024; 49:175-180. [PMID: 38155226 DOI: 10.1007/s00059-023-05230-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND Current guidelines emphasize the diagnostic value of non-cardiac or possibly cardiac chest pain. The goal of this analysis was to determine whether German chest pain units (CPUs) adequately address conditions with "atypical" chest pain in existing diagnostic structures. METHOD A total of 11,734 patients from the German CPU registry were included. The analyses included mode of admission, critical time intervals, diagnostic steps, and differential diagnoses. RESULTS Patients with unspecified chest pain were younger, more often female, were less likely to have classic cardiovascular risk factors and tended to present more often as self-referrals. Patients with acute coronary syndrome (ACS) mostly had prehospital medical contact. Overall, there was no difference between these two groups regarding the time from the onset of first symptoms to arrival at the CPU. In the CPU, the usual basic diagnostic measures were performed irrespective of ACS as the primary working diagnosis. In the non-ACS group, further ischemia-specific diagnostics were rarely performed. Extra-cardiac differential diagnoses were not specified. CONCLUSION The establishment of broader awareness programs and opening CPUs for low-threshold evaluation of self-referring patients should be discussed. Regarding the rigid focus on the clarification of cardiac causes of chest pain, a stronger interdisciplinary approach should be promoted.
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Affiliation(s)
- Sebastian Imhof
- Department of Cardiology, Pneumology, Neurology and Intensive Care, Klinik Kitzinger Land, Kitzingen, Germany
| | - Matthias Hochadel
- Institute for Myocardial Infarction Research Foundation, Ludwigshafen, Germany
| | - Stavros Konstantinides
- Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | | | - Claus Schmitt
- Clinic for Cardiology and Angiology, Municipal Hospital Karlsruhe, Karlsruhe, Germany
| | - Bernd Nowak
- CCB, Cardioangiologisches Centrum Bethanien, Frankfurt am Main, Germany
| | - Tienush Rassaf
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Duisburg-Essen, Essen, Germany
| | - Jochen Senges
- Institute for Myocardial Infarction Research Foundation, Ludwigshafen, Germany
| | - Thomas Münzel
- Department of Cardiology, University Medical Center Mainz, Johannes Gutenberg-University Mainz, Mainz, Germany
| | | | - Frank Breuckmann
- Department of Cardiology, Pneumology, Neurology and Intensive Care, Klinik Kitzinger Land, Kitzingen, Germany.
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Duisburg-Essen, Essen, Germany.
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Inoue A, Mizobe M, Takahashi J, Funakoshi H. Factors for delays in door-to-balloon time ≤ 90 min in an electrocardiogram triage system among patients with ST-segment elevation myocardial infarction: a retrospective study. Int J Emerg Med 2023; 16:77. [PMID: 37919686 PMCID: PMC10621087 DOI: 10.1186/s12245-023-00562-5] [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: 08/22/2023] [Accepted: 10/26/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND Door to balloon time is a crucial factor of mortality in patients with ST-segment elevation myocardial infarction. However, the factors that contribute to failure of achieving door to balloon time ≤ 90 min in an electrocardiogram triage system remain unknown. METHODS This single-center retrospective observational study collected data from consecutive patients with ST-segment elevation myocardial infarction from April 2016 to March 2021. The primary outcome was the failure to achieve door to balloon time ≤ 90 min. A multivariate logistic regression model was performed to predict factors associated with failure to achieve door to balloon time ≤ 90 min. RESULTS In total, 190 eligible patients were included. Of these, the 139 (73.2%) patients with door to balloon time ≤ 90 min were significantly younger compared to those with door to balloon time > 90 min (p = 0.02). However, there was no significant difference in sex and timing of hospital arrival between the door to balloon time ≤ 90 and > 90 min groups. Presence of chest pain and ambulance usage were significantly more frequent in patients with door to balloon time ≤ 90 min (p ≤ 0.01, p = 0.02, respectively). Multivariate analysis showed that absence of chest pain (adjusted odds ratio 4.76; 95% confidence interval, 2.04-11.1; p < 0.01) and non-ambulance usage (adjusted odds ratio 3.53; 95% confidence interval, 1.57-7.94; p < 0.01) are predictive factors of failure to achieve door to balloon time ≤ 90 min. CONCLUSION Patients without chest pain as the chief complaint or non-ambulance usage were significantly associated with the failure to achieve door to balloon time ≤ 90 min.
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Affiliation(s)
- Atsuhito Inoue
- Department of Emergency and Critical Care Medicine, Tokyobay Urayasu Ichikawa Medical Center, 3-4-32 Todaijima, Urayasu, Chiba, 279-0001, Japan.
| | - Michiko Mizobe
- Department of Emergency and Critical Care Medicine, Tokyobay Urayasu Ichikawa Medical Center, 3-4-32 Todaijima, Urayasu, Chiba, 279-0001, Japan
| | - Jin Takahashi
- Department of Emergency and Critical Care Medicine, Tokyobay Urayasu Ichikawa Medical Center, 3-4-32 Todaijima, Urayasu, Chiba, 279-0001, Japan
| | - Hiraku Funakoshi
- Department of Emergency and Critical Care Medicine, Tokyobay Urayasu Ichikawa Medical Center, 3-4-32 Todaijima, Urayasu, Chiba, 279-0001, Japan
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Lu X, Xia W, Wang X, Xie F, Sun X. Factors Associated with Symptom-to-Door Delay in Patients with ST-Segment Myocardial Infarction: A Systematic Review. Prehosp Disaster Med 2023; 38:485-494. [PMID: 37485671 DOI: 10.1017/s1049023x23006039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
BACKGROUND Decreasing symptom-to-door (S2D) delay is of vital importance for reducing morbidity and mortality in patients with ST-segment elevation myocardial infarction (STEMI). The factors associated with S2D delay in STEMI patients have not been well-characterized. OBJECTIVES The aim of this study was to identify factors associated with S2D delay in patients with STEMI. METHODS The PubMed, CINAHL, and Embase databases were searched for data. References from the selected articles and relevant background papers were also manually searched to identify additional eligible studies. The included articles were reviewed and assessed for risk of bias. The level of evidence for each identified factor was evaluated using a semiquantitative synthesis. RESULTS Twelve (12) papers were included in the review. Factors associated with S2D delay were complex and could be divided into sociodemographic, clinical history, and onset characteristics. The level of evidence regarding female sex and diabetes was strong, and the evidence was moderate regarding older age, smoking, history of hypertension, self-transport, or referral. CONCLUSIONS Female sex, older age, previous diabetes, previous hypertension, smoking, and self-transport are all strong or moderate risk factors for S2D time delay in patients with ST-segment myocardial infarction. More efforts should be made to educate at-risk populations concerning symptoms of STEMI and the importance of seeking early medical assistance.
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Affiliation(s)
- Xiuyan Lu
- Cardiology Department, Qingdao Hospital, University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital), Qingdao, Shandong Province, China
| | - Wei Xia
- Cardiology Department, Qingdao Hospital, University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital), Qingdao, Shandong Province, China
| | - Xinru Wang
- Nursing Department, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Fangyu Xie
- Cardiology Department, Qingdao Hospital, University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital), Qingdao, Shandong Province, China
| | - Xiujie Sun
- Nursing Department, Qingdao Hospital, University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital), Qingdao, Shandong Province, China
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Rodríguez-Leor O, Cid-Álvarez AB, Pérez de Prado A, Rosselló X, Ojeda S, Serrador A, López-Palop R, Martín-Moreiras J, Rumoroso JR, Cequier Á, Ibáñez B, Cruz-González I, Romaguera R, Raposeiras S, Moreno R. Analysis of the management of ST-segment elevation myocardial infarction in Spain. Results from the ACI-SEC Infarction Code Registry. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2022; 75:669-680. [PMID: 35067471 DOI: 10.1016/j.rec.2021.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 10/25/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION AND OBJECTIVES ST-segment elevation myocardial infarction (STEMI) networks should guarantee STEMI care with good clinical results and within the recommended time parameters. There is no contemporary information on the performance of these networks in Spain. The objective of this study was to analyze the clinical characteristics of patients, times to reperfusion, characteristics of the intervention performed, and 30-day mortality. METHODS Prospective, observational, multicenter registry of consecutive patients treated in 17 STEMI networks in Spain (83 centers with the Infarction Code), between April 1 and June 30, 2019. RESULTS A total of 5401 patients were attended (mean age, 64±13 years; 76.9% male), of which 4366 (80.8%) had confirmed STEMI. Of these, 87.5% were treated with primary angioplasty, 4.4% with fibrinolysis, and 8.1% did not receive reperfusion. In patients treated with primary angioplasty, the time between symptom onset and reperfusion was 193 [135-315] minutes and the time between first medical contact and reperfusion was 107 [80-146] minutes. Overall 30-day mortality due to STEMI was 7.9%, while mortality in patients treated with primary angioplasty was 6.8%. CONCLUSIONS Most patients with STEMI were treated with primary angioplasty. In more than half of the patients, the time from first medical contact to reperfusion was <120 minutes. Mortality at 30 days was relatively low.
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Affiliation(s)
- Oriol Rodríguez-Leor
- Institut del Cor, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Institut de Recerca en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain.
| | - Ana Belén Cid-Álvarez
- Servicio de Cardiología, Hospital Clínico de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | | | - Xavier Rosselló
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; Servicio de Cardiología, Institut d'Investigació Sanitària Illes Balears (IdISBa), Hospital Universitari Son Espases, Palma de Mallorca, Balearic Islands, Spain
| | - Soledad Ojeda
- Servicio de Cardiología, Hospital Universitario Reina Sofía, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba, Córdoba, Spain
| | - Ana Serrador
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Clínico de Valladolid, Valladolid, Spain
| | - Ramón López-Palop
- Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | - Javier Martín-Moreiras
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
| | - José Ramón Rumoroso
- Servicio de Cardiología, Hospital de Galdakao-Usansolo, Galdakao, Vizcaya, Spain
| | - Ángel Cequier
- Servicio de Cardiología, Hospital de Bellvitge-IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Borja Ibáñez
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; Servicio de Cardiología, IIS-Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Ignacio Cruz-González
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
| | - Rafael Romaguera
- Servicio de Cardiología, Hospital de Bellvitge-IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Sergio Raposeiras
- Servicio de Cardiología, Hospital Universitario Álvaro Cunqueiro, Instituto de Investigación Sanitaria Galicia Sur, Vigo, Pontevedra, Spain
| | - Raúl Moreno
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital de La Paz, Madrid, Spain
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Reconsidering treatment guidelines for acute myocardial infarction during the COVID-19 pandemic. BMC Cardiovasc Disord 2022; 22:194. [PMID: 35473672 PMCID: PMC9040353 DOI: 10.1186/s12872-022-02626-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 04/11/2022] [Indexed: 11/30/2022] Open
Abstract
Background COVID-19 affects healthcare resource allocation, which could lead to treatment delay and poor outcomes in patients with acute myocardial infarction (AMI). We assessed the impact of the COVID-19 pandemic on AMI outcomes. Methods We compared outcomes of patients admitted for acute ST-elevation MI (STEMI) and non-STEMI (NSTEMI) during a non-COVID-19 pandemic period (January–February 2019; Group 1, n = 254) and a COVID-19 pandemic period (January–February 2020; Group 2, n = 124). Results For STEMI patients, the median of first medical contact (FMC) time, door-to-balloon time, and total myocardial ischemia time were significantly longer in Group 2 patients (all p < 0.05). Primary percutaneous intervention was performed significantly more often in Group 1 patients than in Group 2 patients, whereas thrombolytic therapy was used significantly more often in Group 2 patients than in Group 1 patients (all p < 0.05). However, the rates of and all-cause 30-day mortality and major adverse cardiac event (MACE) were not significantly different in the two periods (all p > 0.05). For NSTEMI patients, Group 2 patients had a higher rate of conservative therapy, a lower rate of reperfusion therapy, and longer FMC times (all p < 0.05). All-cause 30-day mortality and MACE were only higher in NSTEMI patients during the COVID-19 pandemic period (p < 0.001). Conclusions COVID-19 pandemic causes treatment delay in AMI patients and potentially leads to poor clinical outcome in NSTEMI patients. Thrombolytic therapy should be initiated without delay for STEMI when coronary intervention is not readily available; for NSTEMI patients, outcomes of invasive reperfusion were better than medical treatment.
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Rodríguez-Leor O, Cid-Álvarez AB, Pérez de Prado A, Rosselló X, Ojeda S, Serrador A, López-Palop R, Martín-Moreiras J, Rumoroso JR, Cequier Á, Ibáñez B, Cruz-González I, Romaguera R, Raposeiras S, Moreno R. Análisis de la atención al infarto con elevación del segmento ST en España. Resultados del Registro de Código Infarto de la ACI-SEC. Rev Esp Cardiol 2021. [DOI: 10.1016/j.recesp.2021.10.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Rubartelli P, Bartolini D, Bellotti S, Fedele M, Iannone A, Masini M, Crimi G. Reasons for reperfusion delay in ST-elevation myocardial infarction and their impact on mortality. J Cardiovasc Med (Hagerstown) 2021; 23:157-164. [PMID: 35103637 DOI: 10.2459/jcm.0000000000001277] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The impact of reperfusion delay in ST-elevation myocardial infarction (STEMI) is well known. We aimed to describe the specific reasons for delay to primary percutaneous coronary intervention (pPCI), and their impact on mortality after adjusting for confounders, using the first-medical-contact-to-device (FMCTD) time to measure the delay. METHODS Between January 2006 and December 2019, 2149 STEMI patients underwent pPCI at our centre. Delayed pPCI was defined as FMCTD > 90 min or > 120 min in the case of inter-hospital transfer. The causes of delay were classified as system-related (related to the network organization) or patient-related (related to the clinical condition of the patient). Primary outcome was 1-year all-cause mortality. RESULTS The pPCI was timely in 69.9% of patients, delayed for system-related causes in 16.4% or for patient-related causes in 13.7%. Different patient-related causes induced variable median FMCTD time (from 114 min for technically difficult pPCI to 159 min for ECG and/or symptom resolution). By multivariable Cox-regression models, the main independent risk factors for mortality were delay due to comorbidities [hazard ratio (HR) 2.19 (1.22-3.91)], or hemodynamic instability [HR 2.05 (1.25-3.38)], after adjusting for Global Registry of Acute Coronary Events risk score tertiles and angiographic success. The difference in risk of mortality is maintained over the entire spectrum of time from symptom onset. CONCLUSIONS Different causes of delay had different impacts on mortality, generally more important than the length of the delay. Causes of delay such as hemodynamic instability and comorbidities should prompt specific programs of performance improvement. Timely pPCI maintains prognostic advantages after several hours from symptom onset, mandating prompt reperfusion also in late-presenter patients.
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An Artificial Intelligence-Based Alarm Strategy Facilitates Management of Acute Myocardial Infarction. J Pers Med 2021; 11:jpm11111149. [PMID: 34834501 PMCID: PMC8623357 DOI: 10.3390/jpm11111149] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 10/28/2021] [Accepted: 11/01/2021] [Indexed: 12/30/2022] Open
Abstract
(1) Background: While an artificial intelligence (AI)-based, cardiologist-level, deep-learning model for detecting acute myocardial infarction (AMI), based on a 12-lead electrocardiogram (ECG), has been established to have extraordinary capabilities, its real-world performance and clinical applications are currently unknown. (2) Methods and Results: To set up an artificial intelligence-based alarm strategy (AI-S) for detecting AMI, we assembled a strategy development cohort including 25,002 visits from August 2019 to April 2020 and a prospective validation cohort including 14,296 visits from May to August 2020 at an emergency department. The components of AI-S consisted of chest pain symptoms, a 12-lead ECG, and high-sensitivity troponin I. The primary endpoint was to assess the performance of AI-S in the prospective validation cohort by evaluating F-measure, precision, and recall. The secondary endpoint was to evaluate the impact on door-to-balloon (DtoB) time before and after AI-S implementation in STEMI patients treated with primary percutaneous coronary intervention (PPCI). Patients with STEMI were alerted precisely by AI-S (F-measure = 0.932, precision of 93.2%, recall of 93.2%). Strikingly, in comparison with pre-AI-S (N = 57) and post-AI-S (N = 32) implantation in STEMI protocol, the median ECG-to-cardiac catheterization laboratory activation (EtoCCLA) time was significantly reduced from 6.0 (IQR, 5.0–8.0 min) to 4.0 min (IQR, 3.0–5.0 min) (p < 0.01). The median DtoB time was shortened from 69 (IQR, 61.0–82.0 min) to 61 min (IQR, 56.8–73.2 min) (p = 0.037). (3) Conclusions: AI-S offers front-line physicians a timely and reliable diagnostic decision-support system, thereby significantly reducing EtoCCLA and DtoB time, and facilitating the PPCI process. Nevertheless, large-scale, multi-institute, prospective, or randomized control studies are necessary to further confirm its real-world performance.
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Thanavaro J, Buchanan P, Stiffler M, Baum K, Bell C, Clark A, Phelan C, Russell N, Teater A, Metheny N. Factors affecting STEMI performance in six hospitals within one healthcare system. Heart Lung 2021; 50:693-699. [PMID: 34107393 DOI: 10.1016/j.hrtlng.2021.04.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 03/31/2021] [Accepted: 04/02/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND How quickly percutaneous coronary intervention is performed in patients with ST-elevation myocardial infarction (STEMI) is a quality measure, reported as door-to-balloon (D2B) time. OBJECTIVES To explore factors affecting STEMI performance in six hospitals in one healthcare system. METHODS This was a retrospective chart review of clinical features and D2B times. Predictors for D2B times were identified using multivariate linear regression. RESULTS The median D2B time for all six hospitals was 63 minutes and all hospitals surpassed the minimal recommended percentage of patients achieving D2B time ≤90 minutes (87.8%vs75%,p<0.001). Patient confounders adversely affect D2B times (+21.5 minutes, p<0.001). Field ECG/activation with emergency department (ED) transport (-22.0 minutes) or direct cardiac catheterization laboratory (CCL) transport (-27.3 minutes) was superior to ED ECG/activation (p<0.001). CONCLUSION Field ECG/STEMI activation significantly shortened D2B time. To improve D2B time, hospital and Emergency Medical Service collaboration should be advocated to increase field activation and direct patient transportation to CCL.
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Affiliation(s)
- Joanne Thanavaro
- St. Louis University Trudy Busch Valentine School of Nursing, St. Louis, Missouri, USA.
| | - Paula Buchanan
- Saint Louis University's Center for Health Outcomes Research (SLUCOR), St. Louis, Missouri, USA.
| | | | | | | | | | | | | | | | - Norma Metheny
- St. Louis University Trudy Busch Valentine School of Nursing, St. Louis, Missouri, USA.
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12
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Boivin-Proulx LA, Matteau A, Pacheco C, Bastiany A, Mansour S, Kokis A, Quan É, Gobeil F, Potter BJ. Effect of Real-Time Physician Oversight of Prehospital STEMI Diagnosis on ECG-Inappropriate and False Positive Catheterization Laboratory Activation. CJC Open 2020; 3:419-426. [PMID: 34027344 PMCID: PMC8129458 DOI: 10.1016/j.cjco.2020.11.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 11/18/2020] [Indexed: 11/26/2022] Open
Abstract
Background ST-elevation myocardial infarction diagnosis at first medical contact (FMC) and prehospital cardiac catheterization laboratory (CCL) activation are associated with reduced total ischemic time and therefore have become the dominant ST-elevation myocardial infarction referral method in primary percutaneous coronary intervention systems. We sought to determine whether physician oversight was associated with improved diagnostic performance in a prehospital CCL activation system and what effect the additional interpretation has on treatment delay. Methods Between 2012 and 2015, all patients in 2 greater Montreal catchment areas with a chief symptom of chest paint or dyspnea had an in-the-field electrocardiogram (ECG). A machine diagnosis of "acute myocardial infarction" resulted either in automatic CCL (automated cohort without oversight) or transmission of the ECG to the receiving centre emergency physician for reinterpretation before CCL activation. System performance was assessed in terms of the proportion of false positive and inappropriate activations (IA), as well as the proportion of patients with FMC-to-device times ≤ 90 minutes. Results Four hundred twenty-eight (428) activations were analyzed (311 automated; 117 with physician oversight). Physician oversight tended to decrease IAs (7% vs 3%; P = 0.062), but was also associated with a smaller proportion of patients achieving target FMC-to-device (76% vs 60%; P < 0.001). There was no significant effect on the proportion of false positive activation. Conclusions Real-time physician oversight might be associated with fewer IAs, but also appears to have a deleterious effect on FMC-to-device performance. Identifying predictors of IA could improve overall performance by selecting ECGs that merit physician oversight and streamlining others. Larger clinical studies are warranted.
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Affiliation(s)
- Laurie-Anne Boivin-Proulx
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec, Canada.,Centre Cardiovasculaire du Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Alexis Matteau
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec, Canada.,Centre Cardiovasculaire du Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
| | | | | | - Samer Mansour
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec, Canada.,Centre Cardiovasculaire du Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
| | - André Kokis
- Centre Cardiovasculaire du Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Éric Quan
- Hôpital Charles-Lemoyne, Greenfield Park, Québec, Canada
| | - François Gobeil
- Centre Cardiovasculaire du Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Brian J Potter
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec, Canada.,Centre Cardiovasculaire du Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
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13
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Mor S, Lev-RN Z, Tal S. Is family history of coronary artery disease important in the emergency department triage? Int Emerg Nurs 2020; 50:100855. [DOI: 10.1016/j.ienj.2020.100855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 03/06/2020] [Accepted: 03/10/2020] [Indexed: 11/25/2022]
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14
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Shin H, Lee I, Kim C, Choi HJ. Point-of-care blood analysis of hypotensive patients in the emergency department. Am J Emerg Med 2019; 38:1049-1057. [PMID: 31492566 DOI: 10.1016/j.ajem.2019.158363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 07/15/2019] [Accepted: 07/21/2019] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE The aim of this study is to compare a point-of-care (POC) analysis, Enterprise POC (epoc), using the capillary blood obtained from skin puncture with conventional laboratory tests using arterial and venous blood in hypotensive patients. METHODS This study was conducted at the emergency department of a tertiary care hospital between June and November 2018. 231 hypotensive patients were enrolled. Three types of blood samples (capillary blood from skin puncture and arterial and venous blood from blood vessel puncture) were collected and analyzed. We compared a total of 13 parameters (pH, pCO2, pO2, HCO3-, Ca2+, lactate, Na+, K+, Cl-, glucose, Hb, Hct, and creatinine) between the POC analysis and reference analyzers by performing the equivalence test and Bland-Altman plot analysis. RESULTS In hypotensive patients, with the exception of two parameters (pCO2, pO2), the pH, HCO3-, Ca2+, lactate, Na+, K+, Cl-, glucose, Hb, Hct, and creatinine parameters measured by the POC analysis were equivalent to or correlated with the reference values. In the patients with cardiac arrest group, nine parameters (pH, HCO3-, Ca2+, Na+, K+, glucose, Hb, Hct, and creatinine) analyzed by the epoc system were equivalent to the reference values. CONCLUSION Most parameters, except pO2, measured by the epoc system using the capillary blood in hypotensive patients were equivalent to or correlated with those measured by the reference analyzers.
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Affiliation(s)
- Hyungoo Shin
- Department of Emergency Medicine, College of Medicine, Hanyang University Guri Hospital, Guri, Republic of Korea
| | - Inhye Lee
- Department of Emergency Medicine, College of Medicine, Hanyang University Guri Hospital, Guri, Republic of Korea
| | - Changsun Kim
- Department of Emergency Medicine, College of Medicine, Hanyang University Guri Hospital, Guri, Republic of Korea.
| | - Hyuk Joong Choi
- Department of Emergency Medicine, College of Medicine, Hanyang University Guri Hospital, Guri, Republic of Korea
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15
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Saban M, Shachar T, Salama R, Darawsha A. Improving STEMI management in the emergency department: Examining the role of minority groups and sociodemographic characteristics. Am J Emerg Med 2019; 38:1102-1109. [PMID: 31400825 DOI: 10.1016/j.ajem.2019.158380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 07/23/2019] [Accepted: 07/30/2019] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To evaluate whether a fast-track intervention program will reduce time-lags of patients with STEMI considering minority groups, various socioeconomic status (SES) and clinical risk factors. METHODS A retrospective-archive study was conducted according to clinical guidelines, comparing all STEMI patients (n = 140) admitted to the emergency department (ED) before (n = 60) and during (n = 80) implementation of the fast track intervention program. The program comprised four steps: (1) immediate bed rest, (2) marking patient chart, (3) assessing time-lags according to defined clinical guidelines, and (4) physician signing a dedicated sticker on the ECG. RESULTS The major ethnic group compared to other minority patients with STEMI were less delayed for physician examination (r = -0.398, p < 0.01), spent less time at ED (r = -0.541, p < 0.01) and reached percutaneous coronary intervention earlier (r = -0.672, p < 0.01). Patients with higher SES spent less time for physician (r = -338, p < 0.05) and in the ED (r = -0.415, p < 0.01). Before intervention patients with diabetes mellitus (DM) spent more time at ED compared to non DM patients, however during intervention this difference was blurred (β = -0.803, p < 0.001). Gaps regarding sociodemographic bias remained present throughout the intervention despite monthly staff evaluations considering patient cases. CONCLUSIONS The fast track intervention was associated with less time at ED and to cardiac reperfusion. Yet, sociodemographic bias was present. Our findings highlight the need for the healthcare profession to address the role of biases in disparities in healthcare.
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Affiliation(s)
- Mor Saban
- Department of Nursing, The Faculty of Health and Welfare Sciences, University of Haifa, Haifa, Israel; Rambam Health Care Campus, Haifa, Israel.
| | - Tal Shachar
- The Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
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16
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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.
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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
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17
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Stassen W, Wallis L, Vincent-Lambert C, Castren M, Kurland L. The proportion of South Africans living within 60 and 120 minutes of a percutaneous coronary intervention facility. Cardiovasc J Afr 2019; 29:6-11. [PMID: 29582877 PMCID: PMC6002799 DOI: 10.5830/cvja-2018-004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 01/14/2018] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Timely reperfusion, preferably via percutaneous coronary intervention (PCI) following myocardial infarction, improves mortality rates. Emergency medical services play a pivotal role in recognising and transporting patients with ST-elevation myocardial infarction directly to a PCI facility to avoid delays to reperfusion. Access to PCI is, in part, dependant on the geographic distribution of patients around PCI facilities. The aim of this study was to determine the proportion of South Africans living within 60 and 120 minutes of a PCI facility. METHODS PCI facility and population data were subjected to proximity analysis to determine the average drive times from municipal ward centroids to PCI facilities for each province in South Africa. Thereafter, the population of each ward living within 60 and 120 minutes of a PCI facility was extrapolated. RESULTS Approximately 53.8 and 71.53% of the South African population live within 60 and 120 minutes of a PCI facility. The median (IQR, range) drive times and distances to a PCI facility are 100 minutes (120.4 min, 0.7-751.8) across 123.6 km (157.6 km, 0.3-940.8). CONCLUSION Based on the proximity of South Africans to PCI facilities, it seems possible that most patients could receive timely PCI within 120 minutes of first medical contact. However, this may be unlikely for some due to a lack of medical insurance, under-developed referral networks or other system delays. Coronary care networks should be developed based on the proximity of communities to 12-lead ECG and reperfusion therapies (such as PCI facilities). Public and private healthcare partnerships should be fortified to allow for patients without medical insurance to have equal accesses to PCI facilities.
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Affiliation(s)
- Willem Stassen
- Department of Clinical Research and Education, Karolinska Institute, Stockholm, Sweden; and Division of Emergency Medicine, Stellenbosch University, Stellenbosch, South Africa.
| | - Lee Wallis
- Division of Emergency Medicine, Stellenbosch University, Stellenbosch, South Africa
| | - Craig Vincent-Lambert
- Department of Emergency Medical Care, University of Johannesburg, Johannesburg, South Africa
| | - Maaret Castren
- Department of Clinical Research and Education, Karolinska Institute, Stockholm, Sweden; and Department of Emergency Medicine and Services, Helsinki University, Helsinki, Finland
| | - Lisa Kurland
- Department of Clinical Research and Education, Karolinska Institute, Sweden; and Department of Medical Sciences, Örebro University, Örebro, Sweden
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18
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Bawaskar HS, Bawaskar PH, Bawaskar PH. Preintensive care: Thrombolytic (streptokinase or tenecteplase) in ST elevated acute myocardial infarction at peripheral hospital. J Family Med Prim Care 2019; 8:62-71. [PMID: 30911482 PMCID: PMC6396635 DOI: 10.4103/jfmpc.jfmpc_297_18] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Coronary artery disease is a major cause of death in India. Sudden death preceded by chest pain is due to acute myocardial infarction. Villagers are aware and afraid of chest pain. Majority of chest pain victims attend the primary physician in golden hours. Hence, primary doctors can play important role for early thrombolysis and salvage the myocardium from irreversible injury. This study determined year mortality in a patient who received the rapid thrombolysis at primary care hospital (streptokinase or tenecteplase) at rural setting. Setting: Peripheral General Hospital Mahad on Mumbai–Goa highway. Patients and Methods: Patients with typical chest pain with electrocardiogram showed ST segment elevated myocardial infarction (STEMI) with or without risk factors admitted from 2005 to march 2016 were studied. Details clinically studied: time interval between chest pain to hospital, hospital to needle time, reperfusion and arrhythmias. Time required for regression of elevated ST segment, a response to thrombolytic (streptokinase or tenecteplase) therapy, is studied. Results: Total 244 patient reported with chest pain of these 35 cases brought dead with history of chest pain and convulsive moment before they died. Of these, 209 patients had acute STEMI. Of these, 162 received streptokinase (STK) and 47 received tenecteplase (TNP)]. Analysis of STK Vs TNP patients 18 (11.11%) versus 3 (6.38%) (P = 0.361) died during the treatment. Around 17 (18.49%) vs 5 (10.63%) (P = 0.941) did not show signs of reperfusion, respectively. Re infarction occurred during hospitalization 3 (2.5%) versus 3 (6.38%) (P = 0.094) cases. Around 12 (7.40%) versus 0% (P = 0.072) died at the end of 12 months of thrombolytic therapy. Conclusion: Thrombolysis of STEMI within golden hours improved the reperfusion. However, 1-year fatality is significance with streptokinase as compared with tenecteplase.
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Affiliation(s)
- Himmatrao S Bawaskar
- Department of Medicine, Bawaskar Hospital and Clinical Research Center, Mahad Raigad, Maharashtra, India
| | - Pramodini H Bawaskar
- Department of Medicine, Bawaskar Hospital and Clinical Research Center, Mahad Raigad, Maharashtra, India
| | - Parag H Bawaskar
- Department of Cardiology, Topiwala National Medical College and BYL Nair Hospital, Mumbai, Maharashtra, India
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19
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Noguchi M, Ako J, Morimoto T, Homma Y, Shiga T, Obunai K, Watanabe H. Modifiable factors associated with prolonged door to balloon time in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Heart Vessels 2018; 33:1139-1148. [PMID: 29736558 DOI: 10.1007/s00380-018-1164-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 04/06/2018] [Indexed: 11/30/2022]
Abstract
Door to balloon (D2B) time was reported an important factor of the clinical outcome of patients with ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI). D2B time is influenced by various factors; however, modifiable factors have not been adequately evaluated. The purpose of this study was to identify modifiable factors associated with prolonged D2B time. We historically included 239 consecutive STEMI patients who visited emergency department and underwent primary PCI between April 2013 and September 2016. We evaluated baseline characteristics, mode and timing of hospital arrival, symptoms and signs, treatment times and angiographic characteristics. Patients with D2B time > 90 min were compared with those with D2B time ≤ 90 min. Modifiable factors associated with prolonged D2B time (> 90 min) were analyzed by multivariable logistic regression model. The median D2B time for the entire cohort was 69 min (interquartile range 54-89) and 24% had a D2B time of > 90 min. Modifiable factors associated with prolonged treatment time (D2B time > 90 min) were electrocardiogram (ECG) to puncture time > 50 min [odds ratios (OR) 96.0, 95% confidence intervals (95% CI) 25.1-652.5, P < 0.0001), door to ECG time > 10 min (OR 49.8, 95% CI 11.8-357.5, P < 0.0001), and puncture to balloon time > 30 min (OR 48.5, 95% CI 12.0-333.8, P < 0.0001). ECG to puncture time > 50 min was the most important modifiable factor associated with prolonged D2B time in STEMI patients.
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Affiliation(s)
- Masahiko Noguchi
- Department of Cardiology, Tokyo Bay Urayasu Ichikawa Medical Center, 3-4-32 Todaijima, Urayasu, Chiba, 279-0001, Japan. .,Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Takeshi Morimoto
- Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Yosuke Homma
- Department of Emergency and Critical Care Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Japan
| | - Takashi Shiga
- Department of Emergency and Critical Care Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Japan
| | - Kotaro Obunai
- Department of Cardiology, Tokyo Bay Urayasu Ichikawa Medical Center, 3-4-32 Todaijima, Urayasu, Chiba, 279-0001, Japan
| | - Hiroyuki Watanabe
- Department of Cardiology, Tokyo Bay Urayasu Ichikawa Medical Center, 3-4-32 Todaijima, Urayasu, Chiba, 279-0001, Japan
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20
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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: 74] [Impact Index Per Article: 12.3] [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).
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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
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21
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Muhrbeck J, Persson J, Hofman-Bang C. Catheterization laboratory activations and time intervals for patients with pre-hospital ECGs. SCAND CARDIOVASC J 2018; 52:74-79. [DOI: 10.1080/14017431.2018.1430899] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Josephine Muhrbeck
- Department of Clinical Sciences, Division of Cardiovascular Medicine, Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden
| | - Jonas Persson
- Department of Clinical Sciences, Division of Cardiovascular Medicine, Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden
| | - Claes Hofman-Bang
- Department of Clinical Sciences, Division of Cardiovascular Medicine, Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden
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22
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Kim C, Kim H. Emergency medical technician-performed point-of-care blood analysis using the capillary blood obtained from skin puncture. Am J Emerg Med 2017. [PMID: 29519760 DOI: 10.1016/j.ajem.2017.12.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE Comparing a point-of-care (POC) test using the capillary blood obtained from skin puncture with conventional laboratory tests. METHODS In this study, which was conducted at the emergency department of a tertiary care hospital in April-July 2017, 232 patients were enrolled, and three types of blood samples (capillary blood from skin puncture, arterial and venous blood from blood vessel puncture) were simultaneously collected. Each blood sample was analyzed using a POC analyzer (epoc® system, USA), an arterial blood gas analyzer (pHOx®Ultra, Nova biomedical, USA) and venous blood analyzers (AU5800, DxH2401, Beckman Coulter, USA). Twelve parameters were compared between the epoc and reference analyzers, with an equivalence test, Bland-Altman plot analysis and linear regression employed to show the agreement or correlation between the two methods. RESULTS The pH, HCO3, Ca2+, Na+, K+, Cl-, glucose, Hb and Hct measured by the epoc were equivalent to the reference values (95% confidence interval of mean difference within the range of the agreement target) with clinically inconsequential mean differences and narrow limits of agreement. All of them, except pH, had clinically acceptable agreements between the two methods (results within target value ≥80%). Of the remaining three parameters (pCO2, pO2 and lactate), the epoc pCO2 and lactate values were highly correlated with the reference device values, whereas pO2 was not. (pCO2: R2=0.824, y=-1.411+0.877·x; lactate: R2=0.902, y=-0.544+0.966·x; pO2: R2=0.037, y=61.6+0.431·x). CONCLUSION Most parameters, except only pO2, measured by the epoc were equivalent to or correlated with those from the reference method.
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Affiliation(s)
- Changsun Kim
- Department of Emergency Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea.
| | - Hansol Kim
- Department of Emergency Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea
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Tra J, de Blok C, van der Wulp I, de Bruijne MC, Wagner C. Multicentre analysis of current ST-elevation myocardial infarction acute care pathways. Open Heart 2017; 4:e000458. [PMID: 28890792 PMCID: PMC5566983 DOI: 10.1136/openhrt-2016-000458] [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] [Received: 07/27/2016] [Revised: 11/23/2016] [Accepted: 12/20/2016] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Rapid reperfusion with percutaneous coronary intervention (PCI) is vital for patients with ST segment elevation myocardial infarction (STEMI). However, the guideline-recommended time targets are regularly exceeded. The goal of this study was to gain insight into how Dutch PCI centres try to achieve these time targets by comparing their care processes with one another and with the European guideline-recommended process. In addition, accelerating factors perceived by care providers were identified. METHODS In this multiple case study, interviews with STEMI care providers were conducted, transcribed and used to create process descriptions per centre. Analyses consisted of within-case and between-case analyses of the processes. Accelerating factors were identified by means of open and axial coding. RESULTS In total, 28 interviews were conducted in six PCI centres. The centres differed from the guideline-recommended process on, for example, additional, unavoidable patient routings and monitoring delays, and from one another on the communication of diagnostic information (eg, transmitting all, only ambiguous or no ECGs) and catheterisation room preparation. These differences indicated diverging choices to maintain a balance between speed and diagnostic accuracy. Factors perceived by care providers as accelerating the process included trust in the tentative diagnosis, and avoiding unnecessary intercaregiver consultations. The combination of processes and accelerating factors were summarised in a model. CONCLUSIONS Numerous differences in processes between PCI centres were identified. Several time-saving strategies were applied by PCI centres, however, in different configurations. To further improve the care for patients with STEMI, best practices can be shared between centres and countries.
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Affiliation(s)
- Joppe Tra
- Department of Occupational and Public Health, EMGO+/VU University Medical Center, Amsterdam, The Netherlands
| | - Carolien de Blok
- Faculty of Economics and Business, Department of Operations, University of Groningen, Groningen, The Netherlands
| | - Ineke van der Wulp
- Department of Occupational and Public Health, EMGO+/VU University Medical Center, Amsterdam, The Netherlands
| | - Martine C de Bruijne
- Department of Occupational and Public Health, EMGO+/VU University Medical Center, Amsterdam, The Netherlands
| | - Cordula Wagner
- Department of Occupational and Public Health, EMGO+/VU University Medical Center, Amsterdam, The Netherlands.,The Netherlands Institute of Health Services Research (NIVEL), Utrecht, The Netherlands
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24
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Kohan LC, Nagarajan V, Millard MA, Loguidice MJ, Fauber NM, Keeley EC. Impact of around-the-clock in-house cardiology fellow coverage on door-to-balloon time in an academic medical center. Vasc Health Risk Manag 2017; 13:139-142. [PMID: 28458558 PMCID: PMC5403126 DOI: 10.2147/vhrm.s132405] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objectives To assess if a change in our cardiology fellowship program impacted our ST elevation myocardial infarction (STEMI) program. Background Fellows covering the cardiac care unit were spending excessive hours in the hospital while on call, resulting in increased duty hours violations. A night float fellow system was started on July 1, 2012, allowing the cardiac care unit fellow to sign out to a night float fellow at 5:30 pm. The night float fellow remained in-house until the morning. Methods We performed a retrospective study assessing symptom onset to arrival, arterial access to first device, and door-to-balloon (D2B) times, in consecutive STEMI patients presenting to our emergency department before and after initiation of the night float fellow system. Results From 2009 to 2013, 208 STEMI patients presented to our emergency department and underwent primary percutaneous coronary intervention. There was no difference in symptom onset to arrival (150±102 minutes vs 154±122 minutes, p=0.758), arterial access to first device (12±8 minutes vs 11±7 minutes, p=0.230), or D2B times (50±32 minutes vs 52±34 minutes, p=0.681) during regular working hours. However, there was a significant decrease in D2B times seen during off-hours (72±33 minutes vs 49±15 minutes, p=0.007). There was no difference in in-hospital mortality (11% vs 8%, p=0.484) or need for intra-aortic balloon pump placement (7% vs 8%, p=0.793). Conclusion In academic medical centers, in-house cardiology fellow coverage during off-hours may expedite care of STEMI patients.
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Affiliation(s)
| | | | - Michael A Millard
- Department of Medicine, University of Virginia, Charlottesville, VA, USA
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25
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Tanaka K, Nakada TA, Fukuma H, Nakao S, Masunaga N, Tomita K, Matsumura Y, Mizushima Y, Matsuoka T. Development of a novel information and communication technology system to compensate for a sudden shortage of emergency department physicians. Scand J Trauma Resusc Emerg Med 2017; 25:6. [PMID: 28114953 PMCID: PMC5260081 DOI: 10.1186/s13049-017-0347-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 01/10/2017] [Indexed: 11/29/2022] Open
Abstract
Background A sudden shortage of physician resources due to overwhelming patient needs can affect the quality of care in the emergency department (ED). Developing effective response strategies remains a challenging research area. We created a novel system using information and communication technology (ICT) to respond to a sudden shortage, and tested the system to determine whether it would compensate for a shortage. Methods Patients (n = 4890) transferred to a level I trauma center in Japan during 2012–2015 were studied. We assessed whether the system secured the necessary physicians without using other means such as phone or pager, and calculated fulfillment rate by the system as a primary outcome variable. We tested for the difference in probability of multiple casualties among total casualties transferred to the ED as an indicator of ability to respond to excessive patient needs, in a secondary analysis before and after system introduction. Results The system was activated 24 times (stand-by request [n = 12], attendance request [n = 12]) in 24 months, and secured the necessary physicians without using other means; fulfillment rate was 100%. There was no significant difference in the probability of multiple casualties during daytime weekdays hours before and after system introduction, while the probability of multiple casualties during night or weekend hours after system introduction significantly increased compared to before system introduction (4.8% vs. 12.9%, P < 0.0001). On the whole, the probability of multiple casualties increased more than 2 times after system introduction 6.2% vs. 13.6%, P < 0.0001). Discussion After introducing the system, probability of multiple casualties increased. Thus the system may contribute to improvement in the ability to respond to sudden excessive patient needs in multiple causalities. Conclusions A novel system using ICT successfully secured immediate responses from needed physicians outside the hospital without increasing user workload, and increased the ability to respond to excessive patient needs. The system appears to be able to compensate for a shortage of physician in the ED due to excessive patient transfers, particularly during off-hours.
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Affiliation(s)
- Kumiko Tanaka
- Senshu Trauma and Critical Care Center, 2-23 Rinku Orai Kita, Osaka, 598-8577, Japan.,Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo, Chiba, 260-8677, Japan
| | - Taka-Aki Nakada
- Senshu Trauma and Critical Care Center, 2-23 Rinku Orai Kita, Osaka, 598-8577, Japan. .,Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo, Chiba, 260-8677, Japan.
| | - Hiroshi Fukuma
- Senshu Trauma and Critical Care Center, 2-23 Rinku Orai Kita, Osaka, 598-8577, Japan
| | - Shota Nakao
- Senshu Trauma and Critical Care Center, 2-23 Rinku Orai Kita, Osaka, 598-8577, Japan
| | - Naohisa Masunaga
- Senshu Trauma and Critical Care Center, 2-23 Rinku Orai Kita, Osaka, 598-8577, Japan
| | - Keisuke Tomita
- Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo, Chiba, 260-8677, Japan
| | - Yosuke Matsumura
- Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo, Chiba, 260-8677, Japan
| | - Yasuaki Mizushima
- Senshu Trauma and Critical Care Center, 2-23 Rinku Orai Kita, Osaka, 598-8577, Japan
| | - Tetsuya Matsuoka
- Senshu Trauma and Critical Care Center, 2-23 Rinku Orai Kita, Osaka, 598-8577, Japan
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Association of Pre-hospital ECG Administration With Clinical Outcomes in ST-Segment Myocardial Infarction: A Systematic Review and Meta-analysis. Can J Cardiol 2016; 32:1531-1541. [DOI: 10.1016/j.cjca.2016.06.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 06/06/2016] [Accepted: 06/06/2016] [Indexed: 02/03/2023] Open
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27
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Potter BJ, Matteau A, Mansour S, Naim C, Riahi M, Essiambre R, Montigny M, Sareault I, Gobeil F. Sustained Performance of a "Physicianless" System of Automated Prehospital STEMI Diagnosis and Catheterization Laboratory Activation. Can J Cardiol 2016; 33:148-154. [PMID: 28024553 DOI: 10.1016/j.cjca.2016.10.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 10/01/2016] [Accepted: 10/09/2016] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Treatment times for primary percutaneous coronary intervention frequently exceed the recommended maximum delay. Automated "physicianless" systems of prehospital cardiac catheterization laboratory (CCL) activation show promise, but have been met with resistance over concerns regarding the potential for false positive and inappropriate activations (IAs). METHODS From 2010 to 2015, first responders performed electrocardiograms (ECGs) in the field for all patients with a complaint of chest pain or dyspnea. An automated machine diagnosis of "acute myocardial infarction" resulted in immediate CCL activation and direct transfer without transmission or human reinterpretation of the ECG prior to patient arrival. Any activation resulting from a nondiagnostic ECG (no ST-elevation) was deemed an IA, whereas activations resulting from ECG's compatible with ST-elevation myocardial infarction but without angiographic evidence of a coronary event were deemed false positive. In 2012, the referral algorithm was modified to exclude supraventricular tachycardia and left bundle branch block. RESULTS There were 155 activations in the early cohort (2010-2012; prior to algorithm modification) and 313 in the late cohort (2012-2015). Algorithm modification resulted in a 42% relative decrease in the rate of IAs (12% vs 7%; P < 0.01) without a significant effect on treatment delay. CONCLUSIONS A combination of prehospital automated ST-elevation myocardial infarction diagnosis and "physicianless" CCL activation is safe and effective in improving treatment delay and these results are sustainable over time. The performance of the referral algorithm in terms of IA and false positive is at least on par with systems that ensure real-time human oversight.
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Affiliation(s)
- Brian J Potter
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec, Canada; Centre Cardiovasculaire du Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada.
| | - Alexis Matteau
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec, Canada; Centre Cardiovasculaire du Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Samer Mansour
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec, Canada; Centre Cardiovasculaire du Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada; Hôpital de la Cité de la Santé, Laval, Québec, Canada
| | - Charbel Naim
- Centre Cardiovasculaire du Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Mounir Riahi
- Centre Cardiovasculaire du Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
| | | | | | | | - François Gobeil
- Centre Cardiovasculaire du Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada; Hôpital de la Cité de la Santé, Laval, Québec, Canada
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28
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Schiele F, Gale CP, Bonnefoy E, Capuano F, Claeys MJ, Danchin N, Fox KAA, Huber K, Iakobishvili Z, Lettino M, Quinn T, Rubini Gimenez M, Bøtker HE, Swahn E, Timmis A, Tubaro M, Vrints C, Walker D, Zahger D, Zeymer U, Bueno H. Quality indicators for acute myocardial infarction: A position paper of the Acute Cardiovascular Care Association. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2016; 6:34-59. [DOI: 10.1177/2048872616643053] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Francois Schiele
- University Hospital of Besancon, EA3920 University of Franche-Comté, Besançon, France
| | - Chris P Gale
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds; York Teaching Hospital NHS Foundation Trust, York, UK
| | - Eric Bonnefoy
- Unité de soins intensifs cardiologiques, Hôpital Cardiologique Louis-Pradel, Bron, France
| | | | - Marc J Claeys
- Cardiology Department, University Hospital Antwerp, Edegem, Belgium
| | - Nicolas Danchin
- Assistance Publique-Hôpitaux de Paris (AP-HP); Hôpital Européen Georges Pompidou (HEGP), Department of Cardiology, Paris, France; Université Paris-Descartes, Paris, France
| | - Keith AA Fox
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Kurt Huber
- 3rd Medical Department, Cardiology and Intensive Care Medicine, Wilhelminenhospital, Vienna, Austria
| | | | | | - Tom Quinn
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Maria Rubini Gimenez
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel
| | - Hans E Bøtker
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Eva Swahn
- Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Sweden
| | - Adam Timmis
- National Institute for Health Research Biomedical Research Unit, Barts Heart Centre, London, UK
| | | | | | - David Walker
- East Sussex Healthcare, Conquest Hospital, Hastings, UK
| | - Doron Zahger
- Department of Cardiology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Uwe Zeymer
- Klinikum Ludwigshafen and Institut für Herzinfarktforschung Ludwigshafen, Ludwigshafen, Germany
| | - Hector Bueno
- Centro Nacional de InvestigacionesCardiovasculares (CNIC), Cardiology Department, Hospital Universitario 12 de Octubre, and Universidad Complutense de Madrid, Madrid, Spain
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Celik T, Balta S, Ozturk C, Kaya MG, Aparci M, Yildirim OA, Demir M, Unlu M, Demirkol S, Kilic S, Iyisoy A. Predictors of No-Reflow Phenomenon in Young Patients With Acute ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention. Angiology 2016; 67:683-689. [DOI: 10.1177/0003319715605977] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
No-reflow is of prognostic value in ST-segment elevation myocardial infarction (STEMI) but has not been extensively investigated in young patients. Young patients with STEMI admitted within 12 hours from symptom onset and treated by primary percutaneous coronary intervention (pPCI) were recruited. Patients were classified into 2 groups based on postintervention thrombolysis in myocardial infarction (TIMI) flow grade; no-reflow: TIMI flow grade 0, 1 or 2 (group 1; n = 27; 21 men, mean age: 42 ± 4 years); and angiographic success: TIMI flow grade 3 (group 2; n = 118; 110 men, mean age: 43 ± 4 years). Adjusted odds ratios were 13.79 for female gender ( P < .001; confidence interval [CI] = 1.88-101.26), 2.09 for pain to balloon time ( P < .017; CI = 1.14-3.812), 12.29 for high TIMI thrombus grade ( P = .012; CI = 1.74-86.94), 0.04 for tirofiban use ( P < .001; CI = 0.01-0.22), 5.19 for mean platelet volume (MPV; P < .001; CI = 2.44-11.01), and 1.008 for platelet–lymphocyte ratio (PLR; P = .034; CI = 1.001-1.016). In conclusion, female gender, pain to balloon time, high TIMI thrombus grade, tirofiban, MPV, and PLR were independent predictors of no-reflow in young patients with STEMI after pPCI.
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Affiliation(s)
- Turgay Celik
- Department of Cardiology, School of Medicine, Gulhane Military Medical Academy, Etlik, Ankara, Turkey
| | - Sevket Balta
- Department of Cardiology, School of Medicine, Gulhane Military Medical Academy, Etlik, Ankara, Turkey
| | - Cengiz Ozturk
- Department of Cardiology, School of Medicine, Gulhane Military Medical Academy, Etlik, Ankara, Turkey
| | - Mehmet Gungor Kaya
- Department of Cardiology, School of Medicine, Erciyes University, Kayseri, Turkey
| | - Mustafa Aparci
- Department of Cardiology, School of Medicine, Gulhane Military Medical Academy, Etlik, Ankara, Turkey
| | - Osman A. Yildirim
- Department of Cardiology, School of Medicine, Gulhane Military Medical Academy, Etlik, Ankara, Turkey
| | - Mustafa Demir
- Department of Cardiology, School of Medicine, Gulhane Military Medical Academy, Etlik, Ankara, Turkey
| | - Murat Unlu
- Department of Cardiology, School of Medicine, Gulhane Military Medical Academy, Etlik, Ankara, Turkey
| | - Sait Demirkol
- Department of Cardiology, School of Medicine, Gulhane Military Medical Academy, Etlik, Ankara, Turkey
| | - Selim Kilic
- Department of Epidemiology, School of Medicine, Gulhane Military Medical Academy, Etlik, Ankara, Turkey
| | - Atila Iyisoy
- Department of Cardiology, School of Medicine, Gulhane Military Medical Academy, Etlik, Ankara, Turkey
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30
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Celik T, Balta S, Mikhailidis DP, Ozturk C, Aydin I, Tok D, Yildirim AO, Demir M, Iyisoy A. The Relation Between No-Reflow Phenomenon and Complete Blood Count Parameters. Angiology 2016; 68:381-388. [PMID: 27418628 DOI: 10.1177/0003319716659193] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The no-reflow (NR) phenomenon represents an acute reduction in coronary blood flow without coronary vessel obstruction, coronary vessel dissection, spasm, or thrombosis. No reflow is an important complication among patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI). The complete blood count (CBC) is one of the most frequently ordered laboratory tests in clinical practice. Various studies have evaluated the performance of CBC parameters to predict disease severity and mortality risk. Automated cell counters are routinely available in many clinical laboratories and can be used to determine red blood cell distrubiton width (RDW), platetecrit, platelet count, and and some ratios like the neutrophil-lymphocyte ratio and RDW-platelet ratio. These hematological markers have been reported to be independent predictors of impaired angiographic reperfusion and long-term mortality among patients with STEMI undergoing pPCI. In this context, we reviewed the role of admission CBC parameters for the prediction of NR in patients with STEMI undergoing pPCI.
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Affiliation(s)
- Turgay Celik
- 1 Department of Cardiology, School of Medicine, Gulhane Military Medical Academy, Ankara, Turkey
| | - Sevket Balta
- 1 Department of Cardiology, School of Medicine, Gulhane Military Medical Academy, Ankara, Turkey
| | - Dimitri P Mikhailidis
- 2 Department of Clinical Biochemistry, University College London Medical School, University College London, London, England
| | - Cengiz Ozturk
- 1 Department of Cardiology, School of Medicine, Gulhane Military Medical Academy, Ankara, Turkey
| | - Ibrahim Aydin
- 3 Department of Clinical Biochemistry, School of Medicine, Gulhane Military Medical Academy, Ankara, Turkey
| | - Duran Tok
- 4 Department of Infectious Diseases, Gulhane Military Medical Academy, School of Medicine, Ankara, Turkey
| | - Ali Osman Yildirim
- 1 Department of Cardiology, School of Medicine, Gulhane Military Medical Academy, Ankara, Turkey
| | - Mustafa Demir
- 1 Department of Cardiology, School of Medicine, Gulhane Military Medical Academy, Ankara, Turkey
| | - Atila Iyisoy
- 1 Department of Cardiology, School of Medicine, Gulhane Military Medical Academy, Ankara, Turkey
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31
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Chen HY, Gore JM, Lapane KL, Yarzebski J, Person SD, Kiefe CI, Goldberg RJ. Decade-long trends in the timeliness of receipt of a primary percutaneous coronary intervention. Clin Epidemiol 2016; 8:141-9. [PMID: 27350759 PMCID: PMC4902148 DOI: 10.2147/clep.s102225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objectives The purpose of this study was to examine decade-long trends (2001–2011) in, and factors associated with, door-to-balloon time within 90 minutes of hospital presentation among patients hospitalized with ST-segment elevation myocardial infarction (STEMI) who received a primary percutaneous coronary intervention (PCI). Methods Residents of central Massachusetts hospitalized with STEMI who received a primary PCI at two major PCI-capable medical centers in central Massachusetts on a biennial basis between 2001 and 2011 comprised the study population (n=629). Multivariable regression analyses were used to examine factors associated with failing to receive a primary PCI within 90 minutes after emergency department (ED) arrival. Results The average age of this patient population was 61.9 years; 30.5% were women, and 91.7% were White. During the years under study, 50.9% of patients received a primary PCI within 90 minutes of ED arrival; this proportion increased from 2001/2003 (17.2%) to 2009/2011 (70.5%) (P<0.001). Having previously undergone coronary artery bypass graft surgery, arriving at the ED by car/walk-in and during off-hours were significantly associated with a higher risk of failing to receive a primary PCI within 90 minutes of ED arrival. Conclusion The likelihood of receiving a timely primary PCI in residents of central Massachusetts hospitalized with STEMI at the major teaching/community medical centers increased dramatically during the years under study. Several groups were identified for purposes of heightened surveillance and intervention efforts to reduce the likelihood of failing to receive a timely primary PCI among patients acutely diagnosed with STEMI.
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Affiliation(s)
- Han-Yang Chen
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Joel M Gore
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA; Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Kate L Lapane
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Jorge Yarzebski
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Sharina D Person
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Catarina I Kiefe
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Robert J Goldberg
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA; Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester, MA, USA
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32
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Jäger B, Farhan S, Rohla M, Christ G, Podczeck-Schweighofer A, Schreiber W, Laggner AN, Weidinger F, Stefenelli T, Delle-Karth G, Kaff A, Maurer G, Huber K. Clinical predictors of patient related delay in the VIENNA ST-elevation myocardial infarction network and impact on long-term mortality. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2016; 6:254-261. [DOI: 10.1177/2048872616633882] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Bernhard Jäger
- Cardiology and Intensive Care Medicine, Wilhelminenhospital, Austria
| | - Serdar Farhan
- Cardiology and Intensive Care Medicine, Wilhelminenhospital, Austria
| | - Miklos Rohla
- Cardiology and Intensive Care Medicine, Wilhelminenhospital, Austria
| | - Günter Christ
- Cardiology, Sozialmedizinsiches Zentrum Süd, Austria
| | | | | | - Anton N Laggner
- Department of Emergency Medicine, University of Medicine, Austria
| | | | | | | | | | - Gerald Maurer
- Department of Cardiology, Medical University Vienna, Austria
| | - Kurt Huber
- Cardiology and Intensive Care Medicine, Wilhelminenhospital, Austria
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Meng M, Gao B, Wang X, Bai ZG, Sa RN, Ge B. Long-term clinical outcomes of everolimus-eluting stent versus paclitaxel-eluting stent in patients undergoing percutaneous coronary interventions: a meta-analysis. BMC Cardiovasc Disord 2016; 16:34. [PMID: 26860585 PMCID: PMC4748592 DOI: 10.1186/s12872-016-0206-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Accepted: 01/29/2016] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Everolimus -eluting stent (EES) is common used in patients undergoing percutaneous coronary interventions (PCI). Our purpose is to evaluate long-term clinical outcomes of everolimus -eluting stent (EES) versus paclitaxel-eluting stent (PES) in patients undergoing percutaneous coronaryinterventions (PCI) in randomized controlled trials (RCTs). METHODS We searched Medline, EMBASE, Cochrane Library, CNKI, VIP and relevant websites ( https://scholar-google-com.ezproxy.lib.usf.edu/ ) for articles to compare outcomes between everolimus-eluting stent and paclitaxel-eluting stent without language or date restriction. RCTs that compared the use of everolimus -eluting stent and paclitaxel-eluting stent in PCI were included. Variables relating to patient, study characteristics, and clinical endpoints were extracted. Meta-analysis was performed using RevMan 5.2 software. RESULTS We identified 6 published studies (from three randomized trials) more on everolimus-eluting stent (n = 3352) than paclitaxel-eluting (n = 1639), with follow-up duration ranging from 3, 4 and 5 years. Three-year outcomes of everolimus-eluting stent compared to paclitaxel-eluting were as following: the everolimus-eluting stent significantly reduced all-cause death (relative risk [RR]:0.63; 95% confidence interval [CI]: 0.46. to 0.82), MACE (RR: 0.56; 95% CI: 0.41 to 0.77), MI (RR: 0.64; 95% CI: 0.48 to 0.86), TLR (RR: 0.72; 95% CI: 0.59 to 0.88), ID-TLR (RR: 0.74; 95% CI: 0.59 to 0.92) and ST (RR: 0.54; 95% CI: 0.32 to 0.90). There was no difference in TVR between the everolimus-eluting and paclitaxel-eluting (RR: 0.76; 95% CI: 0.58 to 1.10); Four-year outcomes of everolimus-eluting compared to paclitaxel-eluting: the everolimus-eluting significantly reduced MACE (RR: 0.44; 95% CI: 0.18 to 0.98) and ID-TLR (RR: 0.47; 95 % CI: 0.23 to 0.97). There was no difference in MI (RR: 0.48; 95% CI: 0.16 to 1.46), TLR (RR: 0.46; 95% CI: 0.20 to 1.04) and ST ((RR: 0.34; 95% CI: 0.05 to 2.39). Five-year outcomes of everolimus-eluting stent compared to paclitaxel-eluting: There was no difference in ID-TLR (RR: 0.67; 95% CI: 0.45 to 1.02) and ST (RR: 0.71; 95% CI: 0.28 to 1.80). CONCLUSIONS In the present meta-analysis, everolimus-eluting appeared to be safe and clinically effective in patients undergoing PCI in comparison to PES in 3-year clinical outcomes; there was similar no difference in reduction of ST between EES and PES in long-term(≥ 4 years) clinical follow-ups. Everolimus-eluting is more safety than paclitaxel-eluting in long-term clinical follow-ups, whether these effects can be applied to different patient subgroups warrants further investigation.
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Affiliation(s)
- Min Meng
- Department of Pharmacy, Gansu Provincial Hospital, Donggang West Road No. 204, Lanzhou, Gansu, 730000, China.
| | - Bei Gao
- Department of Pharmacy, Gansu Provincial Hospital, Donggang West Road No. 204, Lanzhou, Gansu, 730000, China.
| | - Xia Wang
- Department of Pharmacy, Gansu Provincial Hospital, Donggang West Road No. 204, Lanzhou, Gansu, 730000, China.
| | - Zheng-gang Bai
- Evidence-Based Medicine Center, Lanzhou University, Lanzhou, Gansu, 730000, China.
| | - Ri-Na Sa
- Department of Pharmacy, Gansu Provincial Hospital, Donggang West Road No. 204, Lanzhou, Gansu, 730000, China.
| | - Bin Ge
- Department of Pharmacy, Gansu Provincial Hospital, Donggang West Road No. 204, Lanzhou, Gansu, 730000, China.
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Callachan EL, Alsheikh-Ali AA, Bruijns S, Wallis LA. Physician perceptions and recommendations about pre-hospital emergency medical services for patients with ST-elevation acute myocardial infarction in Abu Dhabi. J Saudi Heart Assoc 2016; 28:7-14. [PMID: 26778900 PMCID: PMC4685199 DOI: 10.1016/j.jsha.2015.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 05/18/2015] [Accepted: 05/20/2015] [Indexed: 11/22/2022] Open
Abstract
Introduction Physician perceptions about emergency medical services (EMS) are important determinants of improving pre-hospital care for cardiac emergencies. No data exist on physician attitudes towards EMS care of patients with ST-Elevation Myocardial Infarction (STEMI) in the Emirate of Abu Dhabi. Objectives To describe the perceptions towards EMS among physicians caring for patients with STEMI in Abu Dhabi. Methods We surveyed a convenience sample of physicians involved in the care of patients with STEMI (emergency medicine, cardiology, cardiothoracic surgery and intensive care) in four government facilities with 24/7 Primary PCI in the Emirate of Abu Dhabi. Surveys were distributed using dedicated email links, and used 5-point Likert scales to assess perceptions and attitudes to EMS. Results Of 106 physician respondents, most were male (82%), practicing in emergency medicine (47%) or cardiology (44%) and the majority (63%) had been in practice for >10 years. Less than half of the responders (42%) were “Somewhat Satisfied” (35%) or “Very Satisfied” (7%) with current EMS level of care for STEMI patients. Most respondents were “Very Likely” (67%) to advise a patient with a cardiac emergency to use EMS, but only 39% felt the same for themselves or their family. Most responders were supportive (i.e. “Strongly Agree”) of the following steps to improve EMS care: 12-lead ECG and telemetry to ED by EMS (69%), EMS triage of STEMI to PCI facilities (65%), and activation of PCI teams by EMS (58%). Only 19% were supportive of pre-hospital fibrinolytics by EMS. There were no significant differences in the responses among the specialties. Conclusions Most physicians involved in STEMI care in Abu Dhabi are very likely to advise patients to use EMS for a cardiac emergency, but less likely to do so for themselves or their families. Different specialties had concordant opinions regarding steps to improve pre-hospital EMS care for STEMI.
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Affiliation(s)
- Edward L Callachan
- University of Cape Town, Division of Emergency Medicine, Private Bag X24, Belleville 7535, South Africa
| | - Alawi A Alsheikh-Ali
- Institute of Cardiac Sciences, Sheikh Khalifa Medical City, P.O. Box 59100, Abu Dhabi, United Arab Emirates; Institute for Clinical Research and Health Policy Studies, Tufts University School of Medicine, Boston, MA, USA
| | - Stevan Bruijns
- University of Cape Town, Division of Emergency Medicine, Private Bag X24, Belleville 7535, South Africa
| | - Lee A Wallis
- University of Cape Town, Division of Emergency Medicine, Private Bag X24, Belleville 7535, South Africa
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Paweł S, Grzegorz W, Arkadiusz K, Jeremy C, Jarosław G, Zdzisława KJ. Comparison of transport methods for patients with ST-elevation myocardial infarction to a percutaneous coronary intervention center and determination of factors influencing long-term mortality. Int J Cardiol 2016; 202:135-7. [PMID: 26397401 DOI: 10.1016/j.ijcard.2015.08.171] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 08/21/2015] [Indexed: 11/26/2022]
Affiliation(s)
- Stachowiak Paweł
- Department of Cardiology, Pomeranian Medical University, Szczecin, Poland.
| | - Wójcik Grzegorz
- Department of Cardiology, Pomeranian Medical University, Szczecin, Poland
| | - Kazimierczak Arkadiusz
- Department of Vascular Surgery and Angiology, Pomeranian Medical University, Szczecin, Poland
| | - Clark Jeremy
- Department of Clinical and Molecular Biochemistry, Faculty of Laboratory Diagnostics and Molecular Medicine, Pomeranian Medical University, Szczecin, Poland
| | - Gorący Jarosław
- Department of Cardiology, Pomeranian Medical University, Szczecin, Poland
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van Hout GPJ, Teuben MPJ, Heeres M, de Maat S, de Jong R, Maas C, Kouwenberg LHJA, Koenderman L, van Solinge WW, de Jager SCA, Pasterkamp G, Hoefer IE. Invasive surgery reduces infarct size and preserves cardiac function in a porcine model of myocardial infarction. J Cell Mol Med 2015; 19:2655-63. [PMID: 26282710 PMCID: PMC4627570 DOI: 10.1111/jcmm.12656] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 06/23/2015] [Indexed: 01/10/2023] Open
Abstract
Reperfusion injury following myocardial infarction (MI) increases infarct size (IS) and deteriorates cardiac function. Cardioprotective strategies in large animal MI models often failed in clinical trials, suggesting translational failure. Experimentally, MI is induced artificially and the effect of the experimental procedures may influence outcome and thus clinical applicability. The aim of this study was to investigate if invasive surgery, as in the common open chest MI model affects IS and cardiac function. Twenty female landrace pigs were subjected to MI by transluminal balloon occlusion. In 10 of 20 pigs, balloon occlusion was preceded by invasive surgery (medial sternotomy). After 72 hrs, pigs were subjected to echocardiography and Evans blue/triphenyl tetrazoliumchloride double staining to determine IS and area at risk. Quantification of IS showed a significant IS reduction in the open chest group compared to the closed chest group (IS versus area at risk: 50.9 ± 5.4% versus 69.9 ± 3.4%, P = 0.007). End systolic LV volume and LV ejection fraction measured by echocardiography at follow-up differed significantly between both groups (51 ± 5 ml versus 65 ± 3 ml, P = 0.033; 47.5 ± 2.6% versus 38.8 ± 1.2%, P = 0.005). The inflammatory response in the damaged myocardium did not differ between groups. This study indicates that invasive surgery reduces IS and preserves cardiac function in a porcine MI model. Future studies need to elucidate the effect of infarct induction technique on the efficacy of pharmacological therapies in large animal cardioprotection studies.
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Affiliation(s)
- Gerardus PJ van Hout
- Experimental Cardiology Laboratory, University Medical Center UtrechtUtrecht, The Netherlands
| | - Michel PJ Teuben
- Department of Respiratory Medicine, University Medical Center UtrechtUtrecht, The Netherlands
| | - Marjolein Heeres
- Department of Respiratory Medicine, University Medical Center UtrechtUtrecht, The Netherlands
| | - Steven de Maat
- Department of Clinical Chemistry and Hematology, University Medical Center UtrechtUtrecht, The Netherlands
| | - Renate de Jong
- Department of Anesthesiology, Erasmus Medical CenterRotterdam, The Netherlands
| | - Coen Maas
- Department of Clinical Chemistry and Hematology, University Medical Center UtrechtUtrecht, The Netherlands
| | - Lisanne HJA Kouwenberg
- Experimental Cardiology Laboratory, University Medical Center UtrechtUtrecht, The Netherlands
| | - Leo Koenderman
- Department of Respiratory Medicine, University Medical Center UtrechtUtrecht, The Netherlands
| | - Wouter W van Solinge
- Department of Clinical Chemistry and Hematology, University Medical Center UtrechtUtrecht, The Netherlands
| | - Saskia CA de Jager
- Experimental Cardiology Laboratory, University Medical Center UtrechtUtrecht, The Netherlands
| | - Gerard Pasterkamp
- Experimental Cardiology Laboratory, University Medical Center UtrechtUtrecht, The Netherlands
- Department of Clinical Chemistry and Hematology, University Medical Center UtrechtUtrecht, The Netherlands
| | - Imo E Hoefer
- Experimental Cardiology Laboratory, University Medical Center UtrechtUtrecht, The Netherlands
- Department of Clinical Chemistry and Hematology, University Medical Center UtrechtUtrecht, The Netherlands
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Impact of pre-hospital electrocardiogram teletransmission on time delays in ST segment elevation myocardial infarction patients: a single-centre experience. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2015; 11:212-7. [PMID: 26677362 PMCID: PMC4631736 DOI: 10.5114/pwki.2015.54016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Revised: 11/12/2014] [Accepted: 03/16/2015] [Indexed: 12/05/2022] Open
Abstract
Introduction Delay in diagnosis and treatment has a great influence on morbidity and mortality of ST-segment elevation myocardial infarction (STEMI) patients. Every 30 min of delay in reperfusion is associated with an 8% increase in mortality. ECG teletransmission was proved to effectively shorten time delays in STEMI treatment. In 2012 an ECG teletransmission program was introduced in the Lower Silesia region. Aim To assess the frequency of ECG teletransmission in STEMI patients and its influence on time delays. Material and methods We conducted a retrospective analysis of all patients admitted to our hospital with STEMI in 2013. Time delays, treatment and clinical characteristics of patients with and without teletransmission performed were compared. Results The study included 137 patients, of whom 49 (36%) had teletransmission performed. Direct transport to a percutaneous coronary intervention (PCI)-capable hospital was more frequent in patients with ECG teletransmission performed (88% vs. 63%, p = 0.002). In patients with teletransmission pain-emergency room time and total ischemic time were shorter (respectively 125 (91–184) min vs. 201 (113–339) min, p = 0.001 and 159 (136–244) min vs. 259 (170–389) min, p < 0.001). There were no differences in in-hospital delay, patients’ characteristics, or applied therapy. Conclusions The percentage of STEMI patients who had ECG teletransmission performed was low. Patients with ECG teletransmission had a shorter total ischemic time and lower percentage of indirect transport to a PCI-capable hospital.
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Mikkelsen S, Wolsing-Hansen J, Nybo M, Maegaard CU, Jepsen S. Implementation of the ABL-90 blood gas analyzer in a ground-based mobile emergency care unit. Scand J Trauma Resusc Emerg Med 2015. [PMID: 26224063 PMCID: PMC4520278 DOI: 10.1186/s13049-015-0134-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Point-of Care analysis is increasingly being applied in the prehospital scene. Arterial blood gas analysis is one of many new initiatives adding to the diagnostic tools of the prehospital physician. In this paper we present a study on the feasibility of the Radiometer ABL-90 in a ground-based Mobile Emergency Care Unit and report on some clinical situations in which the apparatus has proven beneficial.
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Affiliation(s)
- Søren Mikkelsen
- Department of Anaesthesiology and Intensive Care Medicine, Mobile Emergency Care Unit, Odense University Hospital, Odense, Denmark.
| | | | - Mads Nybo
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark
| | | | - Søren Jepsen
- Department of Anaesthesiology and Intensive Care Medicine, Mobile Emergency Care Unit, Odense University Hospital, Odense, Denmark
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Kaifoszova Z, Kala P, Alexander T, Zhang Y, Huo Y, Snyders A, Delport R, Alcocer-Gamba MA, Gavidia LML. Stent for Life Initiative: leading example in building STEMI systems of care in emerging countries. EUROINTERVENTION 2015; 10 Suppl T:T87-95. [PMID: 25256540 DOI: 10.4244/eijv10sta14] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
This paper describes the opportunities and challenges in building ST-elevation acute myocardial infarction (STEMI) systems of care in Stent for Life affiliated and collaborating so-called emerging countries, namely India, China, South Africa and Mexico, where CAD mortality is increasing and becoming a significant healthcare problem. The Stent for Life model supports the implementation of ESC STEMI Guidelines in Europe and endeavours to impact on morbidity and mortality by improving services and developing regional STEMI systems of care, whereby STEMI patients' timely access to a primary percutaneous coronary intervention (PPCI) is assured. In India, the STEMI India model incorporates a dual approach of combining PPCI with a pharmacoinvasive strategy of reperfusion. The architecture of the system is based on a hub and spoke model with each unit called a STEMI cluster. The project is driven by a private non-profit organisation. In China, the STEMI PCI programme is led by the Chinese College of Cardiovascular Physicians and supported by the national government. Although primary PCI is performed nationwide, a thrombolytic treatment strategy is still the first option in many rural areas because of logistic considerations. Establishing local STEMI transfer networks and then implementing a pharmacoinvasive strategy of reperfusion are being considered and promoted currently. In South Africa, the pharmacoinvasive approach currently dominates as STEMI treatment option in many areas. A pilot study shows that low symptom awareness leads to long patient delays. The education of all role players, from patients to healthcare professionals and including institutions and governmental structures, is needed to achieve prompt diagnosis and treatment. In Mexico, improving the treatment of STEMI requires considering myocardial infarction to be an emergency that must be treated by an entire system and not just by a particular service. Patients need to receive quick treatment from clinical and interventional cardiologists, and the emergency medical system (EMS) must understand the importance of early reperfusion therapy when appropriate. Mexican health authorities have used registries as their main strategy for improving the use of health resources for ACS patients. In general, building regional STEMI systems of care and an EMS system infrastructure are critical success factors in the stepwise development of STEMI systems of care at a national level in emerging countries as they are in Europe. An in-depth understanding of healthcare system-level barriers to timely and appropriate reperfusion therapy facilitates the development of more effective strategies for improving the quality of STEMI care in each region and country.
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D'Onofrio G, Safdar B, Lichtman JH, Strait KM, Dreyer RP, Geda M, Spertus JA, Krumholz HM. Sex differences in reperfusion in young patients with ST-segment-elevation myocardial infarction: results from the VIRGO study. Circulation 2015; 131:1324-32. [PMID: 25792558 DOI: 10.1161/circulationaha.114.012293] [Citation(s) in RCA: 175] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 01/26/2015] [Indexed: 01/27/2023]
Abstract
BACKGROUND Sex disparities in reperfusion therapy for patients with acute ST-segment-elevation myocardial infarction have been documented. However, little is known about whether these patterns exist in the comparison of young women with men. METHODS AND RESULTS We examined sex differences in rates, types of reperfusion therapy, and proportion of patients exceeding American Heart Association reperfusion time guidelines for ST-segment-elevation myocardial infarction in a prospective observational cohort study (2008-2012) of 1465 patients 18 to 55 years of age, as part of the US Variations in Recovery: Role of Gender on Outcomes of Young AMI Patients (VIRGO) study at 103 hospitals enrolling in a 2:1 ratio of women to men. Of the 1238 patients eligible for reperfusion, women were more likely to be untreated than men (9% versus 4%, P=0.002). There was no difference in reperfusion strategy for the 695 women and 458 men treated. Women were more likely to exceed in-hospital and transfer time guidelines for percutaneous coronary intervention than men (41% versus 29%; odds ratio, 1.65; 95% confidence interval, 1.27-2.16), more so when transferred (67% versus 44%; odds ratio, 2.63; 95% confidence interval, 1.17-4.07); and more likely to exceed door-to-needle times (67% versus 37%; odds ratio, 2.62; 95% confidence interval, 1.23-2.18). After adjustment for sociodemographic, clinical, and organizational factors, sex remained an important factor in exceeding reperfusion guidelines (odds ratio, 1.72; 95% confidence interval, 1.28-2.33). CONCLUSIONS Young women with ST-segment-elevation myocardial infarction are less likely to receive reperfusion therapy and more likely to have reperfusion delays than similarly aged men. Sex disparities are more pronounced among patients transferred to percutaneous coronary intervention institutions or who received fibrinolytic therapy.
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Affiliation(s)
- Gail D'Onofrio
- From Department of Emergency Medicine (G.D., B.S.) and Department of Medicine (R.P.D., H.M.K.), Yale University School of Medicine, New Haven, CT; Yale School of Public Health, New Haven, CT (J.H.L., H.M.K.); The Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (K.M.S., R.P.D., M.G., H.M.K.); Saint Luke's Mid America Heart Institute and the University of Missouri, Kansas City (J.A.S.); and Center of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT (H.M.K.).
| | - Basmah Safdar
- From Department of Emergency Medicine (G.D., B.S.) and Department of Medicine (R.P.D., H.M.K.), Yale University School of Medicine, New Haven, CT; Yale School of Public Health, New Haven, CT (J.H.L., H.M.K.); The Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (K.M.S., R.P.D., M.G., H.M.K.); Saint Luke's Mid America Heart Institute and the University of Missouri, Kansas City (J.A.S.); and Center of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT (H.M.K.)
| | - Judith H Lichtman
- From Department of Emergency Medicine (G.D., B.S.) and Department of Medicine (R.P.D., H.M.K.), Yale University School of Medicine, New Haven, CT; Yale School of Public Health, New Haven, CT (J.H.L., H.M.K.); The Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (K.M.S., R.P.D., M.G., H.M.K.); Saint Luke's Mid America Heart Institute and the University of Missouri, Kansas City (J.A.S.); and Center of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT (H.M.K.)
| | - Kelly M Strait
- From Department of Emergency Medicine (G.D., B.S.) and Department of Medicine (R.P.D., H.M.K.), Yale University School of Medicine, New Haven, CT; Yale School of Public Health, New Haven, CT (J.H.L., H.M.K.); The Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (K.M.S., R.P.D., M.G., H.M.K.); Saint Luke's Mid America Heart Institute and the University of Missouri, Kansas City (J.A.S.); and Center of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT (H.M.K.)
| | - Rachel P Dreyer
- From Department of Emergency Medicine (G.D., B.S.) and Department of Medicine (R.P.D., H.M.K.), Yale University School of Medicine, New Haven, CT; Yale School of Public Health, New Haven, CT (J.H.L., H.M.K.); The Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (K.M.S., R.P.D., M.G., H.M.K.); Saint Luke's Mid America Heart Institute and the University of Missouri, Kansas City (J.A.S.); and Center of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT (H.M.K.)
| | - Mary Geda
- From Department of Emergency Medicine (G.D., B.S.) and Department of Medicine (R.P.D., H.M.K.), Yale University School of Medicine, New Haven, CT; Yale School of Public Health, New Haven, CT (J.H.L., H.M.K.); The Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (K.M.S., R.P.D., M.G., H.M.K.); Saint Luke's Mid America Heart Institute and the University of Missouri, Kansas City (J.A.S.); and Center of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT (H.M.K.)
| | - John A Spertus
- From Department of Emergency Medicine (G.D., B.S.) and Department of Medicine (R.P.D., H.M.K.), Yale University School of Medicine, New Haven, CT; Yale School of Public Health, New Haven, CT (J.H.L., H.M.K.); The Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (K.M.S., R.P.D., M.G., H.M.K.); Saint Luke's Mid America Heart Institute and the University of Missouri, Kansas City (J.A.S.); and Center of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT (H.M.K.)
| | - Harlan M Krumholz
- From Department of Emergency Medicine (G.D., B.S.) and Department of Medicine (R.P.D., H.M.K.), Yale University School of Medicine, New Haven, CT; Yale School of Public Health, New Haven, CT (J.H.L., H.M.K.); The Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (K.M.S., R.P.D., M.G., H.M.K.); Saint Luke's Mid America Heart Institute and the University of Missouri, Kansas City (J.A.S.); and Center of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT (H.M.K.)
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Kuno T, Kohsaka S, Numasawa Y, Ueda I, Suzuki M, Nakamura I, Negishi K, Ishikawa S, Maekawa Y, Kawamura A, Miyata H, Fukuda K. Location of the culprit coronary lesion and its association with delay in door-to-balloon time (from a multicenter registry of primary percutaneous coronary intervention). Am J Cardiol 2015; 115:581-6. [PMID: 25577426 DOI: 10.1016/j.amjcard.2014.12.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2014] [Revised: 12/11/2014] [Accepted: 12/11/2014] [Indexed: 11/18/2022]
Abstract
Current guidelines recommend shorter door-to-balloon times (DBTs) (<90 minutes) for patients with ST-elevation myocardial infarction (STEMI). Clinical factors, including patient or hospital characteristics, associated with prolonged DBT have been identified, but angiographic variables such as culprit lesion location have not been thoroughly investigated. We aimed to evaluate the effect of culprit artery location on DBT of patients with STEMI who underwent percutaneous coronary intervention (PCI). Data were analyzed from 1,725 patients with STEMI who underwent PCI from August 2008 to March 2014 at 16 Japanese hospitals. Patients were divided into 3 groups according to culprit artery location, right coronary artery (RCA), left anterior descending artery (LAD), and left circumflex artery (LC), and associations with DBT were assessed. The LC group had a trend toward a longer DBT among the 3 groups (97.1 [RCA] vs 98.1 [LAD] vs 105.1 [LC] minutes; p = 0.058). In-hospital mortality was also significantly higher in patients with a left coronary artery lesion (3.5% [RCA] vs 6.3% [LAD] vs 5.4% [LC]; p = 0.041). In-hospital mortality for patients with DBT >90 minutes was significantly higher compared with patients with DBT ≤90 minutes (6.5% vs 3.6%; p = 0.006). Multivariate logistic regression analysis revealed that the LC location was an independent predictor for DBT >90 minutes (odds ratio, 1.45; 95% confidence interval, 1.04 to 2.01; p = 0.028). In conclusion, LC location was an independent predictor of longer DBT. The difficulties in diagnosing LC-related STEMI need further evaluation.
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Affiliation(s)
- Toshiki Kuno
- Department of Cardiology, Ashikaga Red Cross Hospital, Tochigi, Japan
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.
| | - Yohei Numasawa
- Department of Cardiology, Ashikaga Red Cross Hospital, Tochigi, Japan
| | - Ikuko Ueda
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Masahiro Suzuki
- Department of Cardiology, Saitama National Hospital, Saitama, Japan
| | - Iwao Nakamura
- Department of Cardiology, Hino City Hospital, Tokyo, Japan
| | - Koji Negishi
- Department of Cardiology, Yokohama Municipal Hospital, Kanagawa, Japan
| | - Shiro Ishikawa
- Department of Cardiology, Saitama City Hospital, Saitama, Japan
| | - Yuichiro Maekawa
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Akio Kawamura
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Hiroaki Miyata
- Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Keiichi Fukuda
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
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Cardiac function in a long-term follow-up study of moderate and severe porcine model of chronic myocardial infarction. BIOMED RESEARCH INTERNATIONAL 2015; 2015:209315. [PMID: 25802838 PMCID: PMC4352740 DOI: 10.1155/2015/209315] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 10/14/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Novel therapies need to be evaluated in a relevant large animal model that mimics the clinical course and treatment in a reasonable time frame. To reliably assess therapeutic efficacy, knowledge regarding the translational model and the course of disease is needed. METHODS Landrace pigs were subjected to a transient occlusion of the proximal left circumflex artery (LCx) (n = 6) or mid-left anterior descending artery (LAD) (n = 6) for 150 min. Cardiac function was evaluated before by 2D echocardiography or 3D echocardiography and pressure-volume loop analysis. At 12 weeks of follow-up the heart was excised for histological analysis and infarct size calculations. RESULTS Directly following AMI, LVEF was severely reduced compared to baseline in the LAD group (-17.1 ± 1.6%, P = 0.009) compared to only a moderate reduction in the LCx group (-5.9 ± 1.5%, P = 0.02) and this effect remained unchanged during 12 weeks of follow-up. CONCLUSION Two models of chronic MI, representative for different patient groups, can reproducibly be created through clinically relevant ischemia-reperfusion of the mid-LAD and proximal LCx.
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Dong S, Chu Y, Zhang H, Wang Y, Yang X, Yang L, Chen L, Yu H. Reperfusion times of ST-Segment elevation myocardial infarction in hospitals. Pak J Med Sci 2015; 30:1367-71. [PMID: 25674140 PMCID: PMC4320732 DOI: 10.12669/pjms.306.5696] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 08/27/2014] [Accepted: 08/28/2014] [Indexed: 12/04/2022] Open
Abstract
Objective: To investigate the reperfusion time in patients with ST-segment elevation myocardial infarction (STEMI) in Henan Province, China, and discuss the strategies for shortening that period. Methods: The reperfusion times of 1556 STEMI cases in 30 hospitals in Henan Province were analyzed from January 2008 to August 2012, including 736 cases from provincial hospitals, 462 cases from municipal hospitals and 358 cases from country hospitals. The following data: Time period 1 (from symptom onset to first medical contact), Time period 2 (from first medical contact to diagnosis), Time period 3 (from the diagnosis to providing consent), Time period 4 (from the time of providing consent to the beginning of treatment) and Time period 5 (from the beginning of treatment to the patency) were recorded and analyzed. Results: In patients receiving primary percutaneous coronary intervention, the door-to-balloon time of provincial hospitals and municipal hospitals was 172±13 minutes and 251±14 minutes, respectively. The hospitals at both levels had a delay comparison of 90 minutes largely caused by the delay in the time for obtaining consent. In patients receiving thrombolysis treatment, the door-to-needle times of provincial hospitals, municipal hospitals and country hospitals were 86±7, 91±7 and 123±11 minutes, respectively. The hospitals at all levels had delays lasting more than 30 minutes, which was mainly attributed to the delay in the time for providing consent. Compared with the time required by the guidelines, the reperfusion time of patients with STEMI in China is evidently delayed. In terms of China's national conditions, the door-to-balloon time is too general. Therefore, we suggest refining this time as the first medical contact–diagnosis time, consent provision time, therapy preparation time and the start of therapy balloon time. Conclusion: Compared to the time required by the guidelines, the reperfusion time of patients with STEMI in China was obviously greater. In terms of China's national conditions, the door to balloon time is not applicable. So it is suggested to refine it as the first medical contact-diagnosis time, providing consent time, therapy prepare time and the start of therapy – balloon time.
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Affiliation(s)
- Shujuan Dong
- Shujuan Dong, Emergency Department of Henan Province People's Hospital, Zhengzhou 450003, China
| | - Yingjie Chu
- Yingjie Chu, Emergency Department of Henan Province People's Hospital, Zhengzhou 450003, China
| | - Haibo Zhang
- Haibo Zhang, Emergency Department of Henan Province People's Hospital, Zhengzhou 450003, China
| | - Yuhang Wang
- Yuhang Wang, Emergency Department of Henan Province People's Hospital, Zhengzhou 450003, China
| | - Xianzhi Yang
- Xianzhi Yang, Emergency Department of Henan Province People's Hospital, Zhengzhou 450003, China
| | - Lei Yang
- Lei Yang, Emergency Department of Henan Province People's Hospital, Zhengzhou 450003, China
| | - Long Chen
- Long Chen, Emergency Department of Henan Province People's Hospital, Zhengzhou 450003, China
| | - Haijia Yu
- Haijia Yu, Emergency Department of Henan Province People's Hospital, Zhengzhou 450003, China
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van Hout G, Jansen of Lorkeers S, Wever K, Sena E, van Solinge W, Doevendans P, Pasterkamp G, Chamuleau S, Hoefer I. Anti-inflammatory compounds to reduce infarct size in large-animal models of myocardial infarction: A meta-analysis. ACTA ACUST UNITED AC 2015. [DOI: 10.1002/ebm2.4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- G.P.J. van Hout
- Experimental Cardiology Laboratory; University Medical Center Utrecht; Utrecht the Netherlands
| | | | - K.E. Wever
- Systematic Review Centre for Laboratory animal Experimentation; Radboud University Nijmegen Medical Center; Nijmegen the Netherlands
| | - E.S. Sena
- Centre for Clinical Brain Sciences; University of Edinburgh; Edinburgh UK
| | - W.W. van Solinge
- Department of Clinical Chemistry and Haematology; University Medical Center Utrecht; Utrecht the Netherlands
| | - P.A. Doevendans
- Experimental Cardiology Laboratory; University Medical Center Utrecht; Utrecht the Netherlands
- Department of Cardiology; University Medical Center Utrecht; Utrecht the Netherlands
| | - G. Pasterkamp
- Experimental Cardiology Laboratory; University Medical Center Utrecht; Utrecht the Netherlands
| | - S.A.J. Chamuleau
- Department of Cardiology; University Medical Center Utrecht; Utrecht the Netherlands
| | - I.E. Hoefer
- Experimental Cardiology Laboratory; University Medical Center Utrecht; Utrecht the Netherlands
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Franco E, Mateos A, Acebal C, Fernández-Ortiz A, Sánchez-Brunete V, García-Rubira JC, Fernández-Campos MJ, Macaya C, Ibáñez B. Prehospital activation of cardiac catheterization teams in ST-segment elevation myocardial infarction. Rev Port Cardiol 2014; 33:545-53. [PMID: 25216540 DOI: 10.1016/j.repc.2014.03.007] [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: 02/04/2014] [Revised: 03/16/2014] [Accepted: 03/17/2014] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES Current clinical guidelines for ST-segment elevation myocardial infarction (STEMI) suggest prehospital activation of the cardiac catheterization team. In previous protocols in our center activation occurred once patients arrived at the hospital. In January 2011, we initiated a new primary angioplasty activation protocol from prehospital locations. Our objective was to quantify the influence of this change on reperfusion times. METHODS A total of 173 consecutive STEMI patients (n=73/100 before/after initiation of the new protocol), diagnosed in a prehospital setting within 12 hours of symptom onset, were analyzed. The time between the patient's arrival at the hospital and beginning of the angioplasty procedure was termed the cath lab activation delay. RESULTS The new protocol resulted in a 37-min reduction in system delay (166 [132-235] min before vs. 129 [105-166] min after, p<0.001), mostly driven by a 64% reduction in cath lab activation delay (55 [0-79] min before vs. 20 [0-54] min after, p=0.001). This reduction was mainly observed outside working hours. The percentage of patients treated with a system delay ≤ 120 min increased from 14.5% before the new protocol to 41.8% afterwards (p=0.001). CONCLUSIONS Prehospital activation of the cardiac catheterization team resulted in earlier reperfusion of STEMI patients.
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Affiliation(s)
- Eduardo Franco
- Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
| | - Alonso Mateos
- Servicio de Urgencia Médica de Madrid (SUMMA 112), Madrid, Spain
| | - Carlos Acebal
- Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
| | - Antonio Fernández-Ortiz
- Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain; Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | | | | | | | - Carlos Macaya
- Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
| | - Borja Ibáñez
- Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain; Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.
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Franco E, Mateos A, Acebal C, Fernández-Ortiz A, Sánchez-Brunete V, García-Rubira JC, Fernández-Campos MJ, Macaya C, Ibáñez B. Prehospital activation of cardiac catheterization teams in ST-segment elevation myocardial infarction. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2014. [DOI: 10.1016/j.repce.2014.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Sullivan AL, Beshansky JR, Ruthazer R, Murman DH, Mader TJ, Selker HP. Factors associated with longer time to treatment for patients with suspected acute coronary syndromes: a cohort study. CIRCULATION-CARDIOVASCULAR QUALITY AND OUTCOMES 2014; 7:86-94. [PMID: 24425697 DOI: 10.1161/circoutcomes.113.000396] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Rapid treatment of acute coronary syndromes (ACS) is important; causes of delay in emergency medical services care of ACS are poorly understood. METHODS AND RESULTS We performed an analysis of data from IMMEDIATE (Immediate Myocardial Metabolic Enhancement during Initial Assessment and Treatment in Emergency Care), a randomized controlled trial of emergency medical services treatment of people with symptoms suggesting ACS, using hierarchical multiple regression of elapsed time. Out-of-hospital ECGs were performed on 54,230 adults calling 9-1-1; 871 had presumed ACS, 303 of whom had ST-segment elevation myocardial infarction and underwent percutaneous coronary intervention. Women, participants with diabetes mellitus, and participants without previous cardiovascular disease waited longer to call 9-1-1 (by 28 minutes, P<0.01; 10 minutes, P=0.03; and 6 minutes, P=0.02, respectively), compared with their counterparts. Time from emergency medical services arrival to ECG was longer for women (1.5 minutes; P<0.01), older individuals (1.3 minutes; P<0.01), and those without a primary complaint of chest pain (3.5 minutes; P<0.01). On-scene times were longer for women (2 minutes; P<0.01) and older individuals (2 minutes; P<0.01). Older individuals and participants presenting on weekends and nights had longer door-to-balloon times (by 10, 14, and 11 minutes, respectively; P<0.01). Women and older individuals had longer total times (medical contact to balloon inflation: 16 minutes, P=0.01, and 9 minutes, P<0.01, respectively; symptom onset to balloon inflation: 31.5 minutes for women; P=0.02). CONCLUSIONS We found delays throughout ACS care, resulting in substantial differences in total times for women and older individuals. These delays may impact outcomes; a comprehensive approach to reduce delay is needed.
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Affiliation(s)
- Alison L Sullivan
- Baystate Medical Center, and Center for Cardiovascular Health Services Research, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA; and Tufts University School of Medicine, and Tufts Clinical and Translational Science Institute, Tufts University, Boston, MA
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Ahn J, Cha KS, Choi JC, Kim JH, Park JS, Lee HW, Oh JH, Choi JH, Lee HC, Hong TJ. The impact of electrocardiogram-guided, direct-targeting intervention of the infarct-related artery on the door-to-balloon time: a pilot study. Int J Cardiol 2013; 168:4530-1. [PMID: 23871636 DOI: 10.1016/j.ijcard.2013.06.100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Accepted: 06/30/2013] [Indexed: 11/24/2022]
Affiliation(s)
- Jinhee Ahn
- Department of Cardiology, Pusan National University Hospital, Busan, South Korea
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Shortest door-to-balloon time in primary percutaneous coronary intervention for a young resident physician suffering from in-hospital inferior ST-segment elevation myocardial infarction. Int J Cardiol 2013; 167:e118-20. [PMID: 23643439 DOI: 10.1016/j.ijcard.2013.04.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Accepted: 04/04/2013] [Indexed: 10/26/2022]
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Benedek I, Gyongyosi M, Benedek T. A prospective regional registry of ST-elevation myocardial infarction in Central Romania: impact of the Stent for Life Initiative recommendations on patient outcomes. Am Heart J 2013; 166:457-65. [PMID: 24016494 DOI: 10.1016/j.ahj.2013.03.033] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Accepted: 03/20/2013] [Indexed: 11/17/2022]
Abstract
BACKGROUND Reperfusion therapy is the treatment of choice in patients with ST-elevation myocardial infarction (STEMI) presenting within 12 hours after the onset of symptoms. However, a significant number of patients do not benefit from it because of the lack of access to well-organized emergency care. We aimed to investigate the evolution of STEMI treatment and mortality between 2004 and 2011 in an unselected population from central Romania and to demonstrate the role of a regional network in increasing the rates of reperfusion therapy with associated reduction of STEMI-related mortality in a region with very low primary percutaneous coronary intervention (pPCI) rates at baseline. METHODS We analyzed the data of 5,899 consecutive patients with STEMI enrolled in this prospective study since 2004, after the initiation of an STEMI network in Central Romania and with continuous support of the Stent for Life Initiative. RESULTS Introduction of the network was associated with an absolute change in the use of reperfusion therapy from 2004 to 2011 (26.94% vs 87.15%, P < .001) and of pPCI (10.88% vs 78.64%, P < .001) for patients presenting within 12 hours after the onset of symptoms, with a decrease of inhospital mortality from 20.73% to 6.35% (P < .001). In addition, the global inhospital mortality of all the STEMI population showed a significant decrease (23.18% vs 13.39%, P < .001). CONCLUSIONS Reduction of STEMI-related mortality was possible via implementation of pPCI, even in a region with low health care expenditures. The organization of an STEMI network led to a significant decrease in STEMI-related mortality, revealing the significant impact of the Stent for Life Initiative recommendations on patient outcomes.
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Affiliation(s)
- Imre Benedek
- University of Medicine and Pharmacy of Targu-Mures, Targu-Mures, Romania
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