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De Marqui Moraes PI, Galhardo A, Barbosa AHP, de Sousa JMA, Alves CMR, Bianco HT, Dos Santos Povoa RM, Stefanini E, Goncalves I, de Almeida DR, Fonseca FAH, de Oliveira Izar MC, Moises VA, Lopes RD, Carvalho AC, Caixeta A. Metrics of care and cardiovascular outcomes in patients with ST-elevation myocardial infarction treated with pharmacoinvasive strategy: a decade-long network in a populous city in Brazil. BMC Cardiovasc Disord 2023; 23:300. [PMID: 37322425 PMCID: PMC10268408 DOI: 10.1186/s12872-023-03340-6] [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] [Received: 12/15/2022] [Accepted: 06/09/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND Pharmacoinvasive strategy is an effective myocardial reperfusion therapy when primary percutaneous coronary intervention (p-PCI) cannot be performed in a timely manner. METHODS Authors sought to evaluate metrics of care and cardiovascular outcomes in a decade-long registry of a pharmacoinvasive strategy network for the treatment of ST-elevation myocardial infarction (STEMI). Data from a local network including patients undergoing fibrinolysis in county hospitals and systematically transferred to the tertiary center were accessed from March 2010 to September 2020. Numerical variables were described as median and interquartile range. Area under the curve (AUC-ROC) was used to analyze the predictive value of TIMI and GRACE scores for in-hospital mortality. RESULTS A total of 2,710 consecutive STEMI patients aged 59 [51-66] years, 815 women (30.1%) and 837 individuals with diabetes (30.9%) were analyzed. The time from symptom onset to first-medical-contact was 120 [60-210] minutes and the door-to-needle time was 70 [43-115] minutes. Rescue-PCI was required in 929 patients (34.3%), in whom the fibrinolytic-catheterization time was 7.2 [4.9-11.8] hours, compared to 15.7 [6.8-22,7] hours in those who had successful lytic reperfusion. All cause in-hospital mortality occurred in 151 (5.6%) patients, reinfarction in 47 (1.7%) and ischemic stroke in 33 (1.2%). Major bleeding occurred in 73 (2.7%) patients, including 19 (0.7%) cases of intracranial bleeding. C-statistic confirmed that both scores had high predictive values for in-hospital mortality, demonstrated by TIMI AUC-ROC of 0.80 [0,77-0.84] and GRACE AUC-ROC of 0.86 [0.83-0.89]. CONCLUSION In a real world registry of a decade-long network for the treatment of ST-elevation myocardial infarction based on the pharmacoinvasive strategy, low rates of in-hospital mortality and cardiovascular outcomes were observed, despite prolonged time metrics for both fibrinolytic therapy and rescue-PCI. Register Clinicaltrials.gov NCT02090712 date of first registration 18/03/2014.
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Affiliation(s)
- Pedro Ivo De Marqui Moraes
- Discipline of Cardiology, Department of Medicine, Universidade Federal de Sao Paulo, Rua Napoleao de Barros, 715, Ground Floor, Hospital Sao Paulo, Vila Clementino, Sao Paulo, SP, CEP (ZIP) 04024-002, Brazil.
| | - Attilio Galhardo
- Discipline of Cardiology, Department of Medicine, Universidade Federal de Sao Paulo, Rua Napoleao de Barros, 715, Ground Floor, Hospital Sao Paulo, Vila Clementino, Sao Paulo, SP, CEP (ZIP) 04024-002, Brazil
| | - Adriano Henrique Pereira Barbosa
- Discipline of Cardiology, Department of Medicine, Universidade Federal de Sao Paulo, Rua Napoleao de Barros, 715, Ground Floor, Hospital Sao Paulo, Vila Clementino, Sao Paulo, SP, CEP (ZIP) 04024-002, Brazil
| | - Jose Marconi Almeida de Sousa
- Discipline of Cardiology, Department of Medicine, Universidade Federal de Sao Paulo, Rua Napoleao de Barros, 715, Ground Floor, Hospital Sao Paulo, Vila Clementino, Sao Paulo, SP, CEP (ZIP) 04024-002, Brazil
| | - Claudia Maria Rodrigues Alves
- Discipline of Cardiology, Department of Medicine, Universidade Federal de Sao Paulo, Rua Napoleao de Barros, 715, Ground Floor, Hospital Sao Paulo, Vila Clementino, Sao Paulo, SP, CEP (ZIP) 04024-002, Brazil
| | - Henrique Tria Bianco
- Discipline of Cardiology, Department of Medicine, Universidade Federal de Sao Paulo, Rua Napoleao de Barros, 715, Ground Floor, Hospital Sao Paulo, Vila Clementino, Sao Paulo, SP, CEP (ZIP) 04024-002, Brazil
| | - Rui Manuel Dos Santos Povoa
- Discipline of Cardiology, Department of Medicine, Universidade Federal de Sao Paulo, Rua Napoleao de Barros, 715, Ground Floor, Hospital Sao Paulo, Vila Clementino, Sao Paulo, SP, CEP (ZIP) 04024-002, Brazil
| | - Edson Stefanini
- Discipline of Cardiology, Department of Medicine, Universidade Federal de Sao Paulo, Rua Napoleao de Barros, 715, Ground Floor, Hospital Sao Paulo, Vila Clementino, Sao Paulo, SP, CEP (ZIP) 04024-002, Brazil
| | - Iran Goncalves
- Discipline of Cardiology, Department of Medicine, Universidade Federal de Sao Paulo, Rua Napoleao de Barros, 715, Ground Floor, Hospital Sao Paulo, Vila Clementino, Sao Paulo, SP, CEP (ZIP) 04024-002, Brazil
| | - Dirceu Rodrigues de Almeida
- Discipline of Cardiology, Department of Medicine, Universidade Federal de Sao Paulo, Rua Napoleao de Barros, 715, Ground Floor, Hospital Sao Paulo, Vila Clementino, Sao Paulo, SP, CEP (ZIP) 04024-002, Brazil
| | - Francisco Antonio Helfenstein Fonseca
- Discipline of Cardiology, Department of Medicine, Universidade Federal de Sao Paulo, Rua Napoleao de Barros, 715, Ground Floor, Hospital Sao Paulo, Vila Clementino, Sao Paulo, SP, CEP (ZIP) 04024-002, Brazil
| | - Maria Cristina de Oliveira Izar
- Discipline of Cardiology, Department of Medicine, Universidade Federal de Sao Paulo, Rua Napoleao de Barros, 715, Ground Floor, Hospital Sao Paulo, Vila Clementino, Sao Paulo, SP, CEP (ZIP) 04024-002, Brazil
| | - Valdir Ambrosio Moises
- Discipline of Cardiology, Department of Medicine, Universidade Federal de Sao Paulo, Rua Napoleao de Barros, 715, Ground Floor, Hospital Sao Paulo, Vila Clementino, Sao Paulo, SP, CEP (ZIP) 04024-002, Brazil
| | - Renato Delascio Lopes
- Discipline of Cardiology, Department of Medicine, Universidade Federal de Sao Paulo, Rua Napoleao de Barros, 715, Ground Floor, Hospital Sao Paulo, Vila Clementino, Sao Paulo, SP, CEP (ZIP) 04024-002, Brazil
- Duke University Hospital, Duke Clinical Research Institute, DUMC, 2400 Pratt Street, Terrace Level Room 0311, Box 3850, Durham, NC, 27705, USA
| | - Antonio Carlos Carvalho
- Discipline of Cardiology, Department of Medicine, Universidade Federal de Sao Paulo, Rua Napoleao de Barros, 715, Ground Floor, Hospital Sao Paulo, Vila Clementino, Sao Paulo, SP, CEP (ZIP) 04024-002, Brazil
| | - Adriano Caixeta
- Discipline of Cardiology, Department of Medicine, Universidade Federal de Sao Paulo, Rua Napoleao de Barros, 715, Ground Floor, Hospital Sao Paulo, Vila Clementino, Sao Paulo, SP, CEP (ZIP) 04024-002, Brazil
- Hospital Israelita Albert Einstein, Av. Albert Einstein, 627/701 - Morumbi, Sao Paulo, SP, CEP (ZIP) 05652-900, Brazil
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Oyatani K, Koyama M, Himuro N, Miura T, Ohnishi H. Characterization of prehospital time delay in primary percutaneous coronary intervention for acute myocardial infarction: analysis of geographical infrastructure-dependent and -independent components. Int J Health Geogr 2023; 22:7. [PMID: 36998077 PMCID: PMC10064653 DOI: 10.1186/s12942-023-00328-5] [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] [Received: 01/08/2023] [Accepted: 03/23/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND Prehospital delay in reaching a percutaneous coronary intervention (PCI) facility is a major problem preventing early coronary reperfusion in patients with ST-elevation myocardial infarction (STEMI). The aim of this study was to identify modifiable factors that contribute to the interval from symptom onset to arrival at a PCI-capable center with a focus on geographical infrastructure-dependent and -independent factors. METHODS We analyzed data from 603 STEMI patients who received primary PCI within 12 h of symptom onset in the Hokkaido Acute Coronary Care Survey. We defined onset-to-door time (ODT) as the interval from the onset of symptoms to arrival at the PCI facility and we defined door-to-balloon time (DBT) as the interval from arrival at the PCI facility to PCI. We analyzed the characteristics and factors of each time interval by type of transportation to PCI facilities. In addition, we used geographical information system software to calculate the minimum prehospital system time (min-PST), which represents the time required to reach a PCI facility based on geographical factors. We then subtracted min-PST from ODT to find the estimated delay-in-arrival-to-door (eDAD), which represents the time required to reach a PCI facility independent of geographical factors. We investigated the factors related to the prolongation of eDAD. RESULTS DBT (median [IQR]: 63 [44, 90] min) was shorter than ODT (median [IQR]: 104 [56, 204] min) regardless of the type of transportation. However, ODT was more than 120 min in 44% of the patients. The min-PST (median [IQR]: 3.7 [2.2, 12.0] min) varied widely among patients, with a maximum of 156 min. Prolongation of eDAD (median [IQR]: 89.1 [49, 180] min) was associated with older age, absence of a witness, onset at night, no emergency medical services (EMS) call, and transfer via a non-PCI facility. If eDAD was zero, ODT was projected to be less than 120 min in more than 90% of the patients. CONCLUSIONS The contribution of geographical infrastructure-dependent time in prehospital delay was substantially smaller than that of geographical infrastructure-independent time. Intervention to shorten eDAD by focusing on factors such as older age, absence of a witness, onset at night, no EMS call, and transfer via a non-PCI facility appears to be an important strategy for reducing ODT in STEMI patients. Additionally, eDAD may be useful for evaluating the quality of STEMI patient transport in areas with different geographical conditions.
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Affiliation(s)
- Keisuke Oyatani
- Department of Public Health, Sapporo Medical University School of Medicine, S-1, W-17, Chuo-Ku, Sapporo, 060-8556, Japan
- Department of Pediatrics, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Masayuki Koyama
- Department of Public Health, Sapporo Medical University School of Medicine, S-1, W-17, Chuo-Ku, Sapporo, 060-8556, Japan.
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan.
| | - Nobuaki Himuro
- Department of Public Health, Sapporo Medical University School of Medicine, S-1, W-17, Chuo-Ku, Sapporo, 060-8556, Japan
| | - Tetsuji Miura
- Department of Clinical Pharmacology, Faculty of Pharmaceutical Sciences, Hokkaido University of Science, Sapporo, Japan
| | - Hirofumi Ohnishi
- Department of Public Health, Sapporo Medical University School of Medicine, S-1, W-17, Chuo-Ku, Sapporo, 060-8556, Japan
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
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