The impact of introduction of Code-STEMI program on the reduction of door-to-balloon time in acute ST-elevation myocardial infarction patients undergoing primary percutaneous coronary intervention: A single-center study in Saudi Arabia

Sex differences in delay times in ST-segment elevation myocardial infarction: A cohort study

BACKGROUND

The present study analyzes a cohort of consecutive patients with ST-segment elevation acute myocardial infarction (STEMI), evaluating the ischemia-reperfusion times from the perspective of gender differences (females versus males), with a long-term follow-up.

METHODS

Single-center analytical cohort study of patients with STEMI in a tertiary hospital, between January 2015 and December 2020.

RESULTS

A total of 2668 patients were included, 2002 (75%) men and 666 (25%) women. The time elapsed from the onset of symptoms to the opening of the artery was 197min (IQR 140-300) vs 220min (IQR 152-340), p=0.004 in men and women respectively. A delay in health care significantly impacts the occurrence of cardiovascular adverse events at follow-up, HR 1.34 [95%CI 1.06-1.70]; p=0.015.

CONCLUSIONS

Women took longer to go to health care services and had a longer delay both in the diagnosis of STEMI and in coronary reperfusion. It is imperative to emphasize the necessity of educating women about the recognition of ischemic heart disease symptoms, empowering them to raise early alarms and seek timely medical attention.

CODE STEMI Program Improves Clinical Outcome in ST Elevation Myocardial Infarction Patients: A Retrospective Cohort Study

Purpose

One of the most frequent causes of cardiac mortality is ST elevation myocardial infarction (STEMI). Delay in the management of STEMI patients is a cause of high mortality and morbidity. This study aims to determine the effect of the implementation of the CODE STEMI program on major adverse cardiac events (MACE) and mortality of STEMI patients at Dr. Cipto Mangunkusumo General Hospital.

Patients and Methods

This was a retrospective cohort study that enrolled 207 STEMI patients who underwent primary percutaneous coronary intervention (PPCI) in 2015–2018. The patients were divided into two groups. The first group was treated prior to establishing the CODE STEMI program. The other group was treated according to the program, which was implemented in January 2017. Data were collected from medical records, and we retrospectively analyzed all in-hours, MACE, and mortality of STEMI patients from both groups as primary outcomes. Data analysis was done using the Mann–Whitney and chi-square test.

Results

There were 72 and 135 patients in the pre‐CODE STEMI and CODE STEMI groups, respectively. D2BT was significantly reduced by 130 min (288±306 vs 158±81, P< 0.001) since the implementation of CODE STEMI program. There were trends to lower in-hospital mortality rates (8.3% vs 4.4%, RR = 0.53) and MACE at 30 days (48.61% vs 37.78%, RR = 0.77).

Conclusion

Implementation of the CODE STEMI program can reduce door-to-balloon time and decrease the MACE and mortality rate in STEMI patients in general hospitals.

WeChat Group of Chest Pain Center for Patients with Acute ST-segment Elevation Myocardial Infarction: Faster Treatment Speed and Better Prognosis

Objective: To explore the effect of establishing a WeChat platform for a chest pain center as a medium to increase the treatment speed and improve the prognosis of patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI).Methods: The chest pain center, established by the creation of a WeChat group, included primary hospitals in Chongqing that are not able to perform PPCI and the First Affiliated Hospital of Chongqing Medical University, which is the core of the center and which includes medical staff of the catheter laboratory, the cardiology department, the emergency, the vascular surgery department, and the cardiothoracic surgery department. Patients with acute STEMI who underwent PPCI from January 2017 to November 2018 in the First Affiliated Hospital of Chongqing Medical University were enrolled. The patients (including emergency department visitors, 120 callers, and patients transferred from the critical care unit or other departments) were divided into a WeChat pre-admission startup group (n=311) and a non-WeChat pre-admission startup group (control group, n=172). Patients’ door-to-balloon time, standard door-to-balloon time achievement rate, artery puncture to balloon dilation time, heart failure rate, length of stay, and incidence of adverse events (including fatal arrhythmia, cardiogenic shock, and death) during hospitalization were compared between the two groups.Results: Four hundred eight-three consecutive patients were enrolled. There was no significant difference in patients’ sex, age, length of stay, and cardiovascular events during hospitalization between the two groups (P>0.05). The door-to-balloon time of the patients in the WeChat pre-admission startup group was much shorter than that of patients in the non-WeChat pre-admission startup group (27.35±10.58 min vs. 88.15±53.79 min, P<0.05). The standard door-to-balloon time achievement rate was significantly higher in the WeChat pre-admission startup group than in the non-WeChat pre-admission startup group (100% vs. 72.09%, P<0.05).Conclusion: The application of a WeChat platform significantly shortened the door-to-balloon time of patients receiving PPCI and increased the standard door-to-balloon time achievement rate for patients with STEMI. In addition, the platform is also conducive to integrating medical resources and sharing medical information. The establishment of the platform increased the treatment speed and improved the prognosis of patients with STEMI.