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Tickley I, Van Blydenstein SA, Meel R. Time to thrombolysis and factors contributing to delays in patients presenting with ST-elevation myocardial infarction at Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa. S Afr Med J 2023; 113:53-58. [PMID: 37882136 DOI: 10.7196/samj.2023.v113i9.500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Acute coronary syndrome is a public health burden both worldwide and in South Africa (SA). Guidelines recommend thrombolysis within 1 hour of symptom onset and 30 minutes of hospital arrival for patients with ST-elevation myocardial infarction (STEMI) in order to prevent morbidity and mortality. There is a paucity of data pertaining to the time between onset of chest pain and thrombolysis in STEMI patients in SA. OBJECTIVES To elucidate the time to thrombolytic therapy, establish the reasons for treatment delays, and calculate the loss of benefit of thrombolysis associated with delays in treatment of patients presenting with STEMI at Chris Hani Baragwanath Academic Hospital (CHBAH), Johannesburg, SA. METHOD A prospective observational study of 100 consecutive patients with STEMI was conducted at CHBAH (2021 - 2022). RESULTS The mean (standard deviation) age was 55.6 (11.6) years, with a male predominance (78%). Thrombolytic therapy was administered to 51 patients, with a median (interquartile range (IQR)) time to thrombolysis of 360 (258 - 768) minutes; 10 of the patients who received a thrombolytic (19.6%) did so within 30 minutes of arrival at the hospital. The median (IQR) time from symptom onset to calling for help was 60 (30 - 240) minutes, the median time from arrival of help to hospital arrival was 114 (48 - 468) minutes, and the median in-hospital delay to thrombolysis after arrival was 105 (45 - 240) minutes. Numerous reasons that led to delay in treatment were identified, but the most frequent was prehospital delays related to patient factors. Late presentation resulted in 26/49 patients (53.1%) not receiving thrombolytic therapy. Five patients died and 43 suffered from heart failure. Thirty per 1 000 participants could have been saved had they received thrombolytic therapy within 1 hour from the onset of chest pain. CONCLUSION Prehospital and hospital-related factors played a significant role in delays to thrombolysis that led to increased morbidity and mortality of patients with STEMI.
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Affiliation(s)
- I Tickley
- Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - S A Van Blydenstein
- Department of Internal Medicine and Division of Pulmonology, Faculty of Health Sciences, University of the Witwatersrand and Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa.
| | - R Meel
- 1 Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
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Balhi S, Jebali A, Sammali H, Boughallaba MA, Ammar I, Ben Abdelaziz A. [Evaluating the performance of Tunisian regional hospitals. Study Protocol of management delays of ST elevation myocardial infarction]. LA TUNISIE MEDICALE 2022; 100:719-725. [PMID: 36571757 PMCID: PMC9841464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
RESEARCH PROBLEM ST Elevation Myocardial Infarction (STEMI+) is an absolute emergency. The young age of patients and the difficulty of access to care remain the main characteristics of STEMI+ management in Tunisia. In the governorate of Béja, located in the Northwestern region of Tunisia, given the lack of a cardiology interventional room in the hospital and in the private establishments of the region and the distance from the specialized centers of at least 127 km, the patient is beyond 90 min of the transfer. This delay in care generates a heavy burden of morbidity and mortality. The main objective of this study will be to audit the delays of management of patients presenting STEMI+ at the regional hospital of Béja (Tunisia) in accordance with the recommendations of learned societies. Secondarily, we will identify factors associated with delayed presentation after the onset of clinical symptoms. Investigation process : it will be a descriptive, exhaustive and prospective study, including patients admitted to the emergency and/or the cardiology department of the regional hospital of Béja for STEMI+ during the study period. For each patient admitted for STEMI, the following data will be collected : sociodemographic characteristics; medical history; cardiovascular risk factors; diagnostic and therapeutic management modalities; intra-hospital evolution; survival at 01 months in relation to the current coronary episode and the estimation of the different management delays. RESEARCH PLAN ethical considerations will be respected, as well as the confidentiality and anonymity of the data. The study will last one year from the 1st september 2022 to 31 august 2023. The results will allow us to describe the delays of management of patients with STEMI+ in the region of Béja (Tunisia). At least 2 publications in international scientific journals are planned.
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Affiliation(s)
- Salma Balhi
- 1. Laboratoire de Recherche LR19SP0 /Faculté de médecine de Sousse/Université de Sousse
| | - Amina Jebali
- 2. Service des urgences, Hôpital régional de Béja / Ministère de la Santé publique
| | - Hichem Sammali
- 3. Service de cardiologie, Hôpital régional de Béja / Ministère de la santé publique.
| | | | | | - Ahmed Ben Abdelaziz
- 1. Laboratoire de Recherche LR19SP0 /Faculté de médecine de Sousse/Université de Sousse
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Oleynikov VE, Matskeplishvili S, Shigotarova E, Kulyutsin A, Burko N. Diagnosis of coronary artery rethrombosis after effective systemic thrombolytic therapy in patients with ST-segment elevation myocardial infarction. J Investig Med 2022; 70:892-898. [PMID: 35046117 DOI: 10.1136/jim-2021-001945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2021] [Indexed: 11/04/2022]
Abstract
The aim of the study was to evaluate the diagnostic significance of ST-segment re-elevation episodes registered with telemetric ECG monitoring in patients with ST-segment elevation myocardial infarction (STEMI) treated with thrombolytic therapy (TLT). The study included 117 patients with STEMI following effective TLT. The elective coronary angiography followed by percutaneous coronary interventions was performed in the interval from 3 to 24 hours after a successful systemic TLT. Before and after cardiac catheterization, the telemetric ECG monitoring was performed using AstroCard Telemetry system (Meditec, Russia). During the study, two groups of patients were formed. Group 1 included 85 patients (72.6%) without new ST-segment deviations on telemetry. 77 patients (90.6%) had no recurrent coronary artery thrombosis at angiography. Eight patients (9.4%) from group 1 were diagnosed with thrombosis of the infarct-related coronary artery. Group 2 included 32 patients (27.4%) who underwent TLT and then had ST-segment re-elevation episodes of 1 mV or more in the infarct-related leads, lasting for at least 1 minute. In group 2, in 27 of 32 patients (84.4%), thrombosis of the infarct-related coronary artery was confirmed (p<0.01 compared with group 1). In 71.9% cases, the recurrent ischemic episodes were asymptomatic ('painless myocardial ischemia') (p<0.01). Thus, in patients with STEMI and successful TLT, re-elevation of ST-segment during remote ECG monitoring is strongly related to angiographically documented coronary artery thrombotic reocclusion. The absence of chest pain during recurrent myocardial ischemia requires continuous ECG telemetry to select patients for the rescue percutaneous coronary interventions at an earlier stage.
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Affiliation(s)
| | - Simon Matskeplishvili
- Cardiology Department, Lomonosov Moscow State University Clinic, Moscow, Russian Federation
| | | | - Alexey Kulyutsin
- Therapy Department, Penza State University, Penza, Russian Federation
| | - Nadezhda Burko
- Therapy Department, Penza State University, Penza, Russian Federation
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Impacto de las diferencias de sexo y los sistemas de red en la mortalidad hospitalaria de pacientes con infarto agudo de miocardio con elevación del segmento ST. Rev Esp Cardiol 2021. [DOI: 10.1016/j.recesp.2020.07.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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5
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Sambola A, Elola FJ, Ferreiro JL, Murga N, Rodríguez-Padial L, Fernández C, Bueno H, Bernal JL, Cequier Á, Marín F, Anguita M. Impact of sex differences and network systems on the in-hospital mortality of patients with ST-segment elevation acute myocardial infarction. ACTA ACUST UNITED AC 2020; 74:927-934. [PMID: 32888884 DOI: 10.1016/j.rec.2020.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 07/14/2020] [Indexed: 01/09/2023]
Abstract
INTRODUCTION AND OBJECTIVES Network systems have achieved reductions in both time to reperfusion and in-hospital mortality in patients with ST-segment elevation myocardial infarction (STEMI). However, the data have not been disaggregated by sex. The aim of this study was to analyze the influence of network systems on sex differences in primary percutaneous coronary intervention (pPCI) and in-hospital mortality from 2005 to 2015. METHODS The Minimum Data Set of the Spanish National Health System was used to identify patients with STEMI. Logistic multilevel regression models and Poisson regression analysis were used to calculate risk-standardized in-hospital mortality ratios and incidence rate ratios (IRRs). RESULTS Of 324 998 STEMI patients, 277 281 were selected after exclusions (29% women). Even when STEMI networks were established, the use of reperfusion therapy (PCI, fibrinolysis, and CABG) was lower in women than in men from 2005 to 2015: 56.6% vs 75.6% in men and 36.4% vs 57.0% in women, respectively (both P<.001). pPCI use increased from 34.9% to 68.1% in men (IRR, 1.07) and from 21.7% to 51.7% in women (IRR, 1.08). The crude in-hospital mortality rate was higher in women (9.3% vs 18.7%; P<.001) but decreased from 2005 to 2015 (IRRs, 0.97 for men and 0.98 for women; both P < .001). Female sex was an independent risk factor for mortality (adjusted OR, 1.23; P<.001). The risk-standardized in-hospital mortality ratio was lower in women when STEMI networks were in place (16.9% vs 19.1%, P<.001). pPCI and the presence of STEMI networks were associated with lower in-hospital mortality in women (adjusted ORs, 0.30 and 0.75, respectively; both P<.001). CONCLUSIONS Women were less likely to receive pPCI and had higher in-hospital mortality than men throughout the 11-year study period, even with the presence of a network system for STEMI.
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Affiliation(s)
- Antonia Sambola
- Servicio de Cardiología, Hospital Universitari Vall d'Hebron, Universitat Autònoma, Barcelona, Spain; Institut de Recerca, Hospital Universitari Vall d'Hebron, Universitat Autònoma, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain.
| | - Francisco Javier Elola
- Fundación Instituto para la Mejora de la Asistencia Sanitaria (Fundación IMAS), Madrid, Spain
| | - José Luis Ferreiro
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Área de Enfermedades del Corazón, Hospital Universitario de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Nekane Murga
- Consejería de Salud del Gobierno Vasco, Vitoria, Álava, Spain
| | | | - Cristina Fernández
- Fundación Instituto para la Mejora de la Asistencia Sanitaria (Fundación IMAS), Madrid, Spain; Servicio de Medicina Preventiva, Hospital Clínico Universitario San Carlos, Universidad Complutense de Madrid, Madrid, Spain
| | - Héctor Bueno
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - José Luis Bernal
- Fundación Instituto para la Mejora de la Asistencia Sanitaria (Fundación IMAS), Madrid, Spain; Servicio de Control de Gestión, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Ángel Cequier
- Servicio de Cardiología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Francisco Marín
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, IMIB-Arrixaca, El Palmar, Murcia, Spain
| | - Manuel Anguita
- Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain
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A Long-Forgotten Tale: The Management of Cardiogenic Shock in Acute Myocardial Infarction. JOURNAL OF CARDIOVASCULAR EMERGENCIES 2019. [DOI: 10.2478/jce-2018-0023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Patients with acute myocardial infarction (AMI) complicated with cardiogenic shock (CS) present one of the highest mortality rates recorded in critical care. Mortality rate in this setting is reported around 45-50% even in the most experienced and well-equipped medical centers. The continuous development of ST-segment elevation acute myocardial infarction (STEMI) networks has led not only to a dramatic decrease in STEMI-related mortality, but also to an increase in the frequency of severely complicated cases who survive to be transferred to tertiary centers for life-saving treatments. The reduced effectiveness of vasoactive drugs on a severely altered hemodynamic status led to the development of new devices dedicated to advanced cardiac support. What’s more, efforts are being made to reduce time from first medical contact to initiation of mechanical support in this particular clinical context. This review aims to summarize the most recent advances in mechanical support devices, in the setting of CS-complicated AMI. At the same time, the review presents several modern concepts in the organization of complex CS centers. These specialized hubs could improve survival in this critical condition.
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Ogunbayo GO, Misumida N, Ayoub K, Hailemariam Y, Hillerson D, Elbadawi A, Abdel-Latif A, Smyth S, Ziada K, Messerli AW. Temporal trends, characteristics and outcomes of fibrinolytic therapy for ST-elevation myocardial infarction among patients 80 years or older. Catheter Cardiovasc Interv 2018; 92:E425-E432. [PMID: 30269436 DOI: 10.1002/ccd.27833] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 06/30/2018] [Accepted: 07/28/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Pharmacologic reperfusion therapy is a recommended and effective strategy in patients with ST-elevation myocardial infarction (STEMI) when percutaneous coronary intervention (PCI) is not available. This study investigates temporal trends and outcomes of fibrinolytic therapy (FT) in elderly patients with STEMI. METHODS Using the Nationwide Inpatient Sample database, we extracted patients ≥80 years a primary diagnosis of STEMI admitted between 2010 and 2014. Using ICD codes, we identified patients who underwent FT. We performed temporal trend analysis, then compared characteristics and inpatient outcomes in the FT group versus no-FT group. Our primary outcome of interest was hemorrhagic stroke (HS). We also assessed the impact of HS on mortality and discharge to skilled nursing facility (SNF). RESULTS Of the 917,307 patients with STEMI, 16.1% (n = 147,874) were aged 80 or older. Primary PCI was performed in 46.2%, 2.4% underwent FT, and 51.3% had neither pharmacologic nor mechanical revascularization. The rate of FT increased (1.9%-2.4%) in a nonlinear trend over the five years of the study. The FT group was eight times more likely to suffer HS (P < 0.001). FT was an independent predictor of HS (OR 7.90, 95% CI 4.36-14.30; P < 0.001), whether they underwent PCI or not. HS was an independent predictor of mortality and SNF discharge. CONCLUSION FT in patients 80 years or older presenting with STEMI was associated with an eight-fold increase in HS and no associated mortality advantage, both with or without PCI. These data underscore the increased risk of FT in the elderly.
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Affiliation(s)
- Gbolahan O Ogunbayo
- Division of Cardiovascular Medicine, University of Kentucky, Lexington, Kentucky
| | - Naoki Misumida
- Division of Cardiovascular Medicine, University of Kentucky, Lexington, Kentucky
| | - Karam Ayoub
- Division of Cardiovascular Medicine, University of Kentucky, Lexington, Kentucky
| | - Yared Hailemariam
- Division of Cardiovascular Medicine, University of Kentucky, Lexington, Kentucky
| | - Dustin Hillerson
- Division of Cardiovascular Medicine, University of Kentucky, Lexington, Kentucky
| | - Ayman Elbadawi
- Department of Internal Medicine, Rochester General Hospital, Rochester, New York
| | - Ahmed Abdel-Latif
- Division of Cardiovascular Medicine, University of Kentucky, Lexington, Kentucky
| | - Susan Smyth
- Division of Cardiovascular Medicine, University of Kentucky, Lexington, Kentucky
| | - Khaled Ziada
- Division of Cardiovascular Medicine, University of Kentucky, Lexington, Kentucky
| | - Adrian W Messerli
- Division of Cardiovascular Medicine, University of Kentucky, Lexington, Kentucky
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Kobayashi N, Takano M, Tsurumi M, Shibata Y, Nishigoori S, Uchiyama S, Okazaki H, Shirakabe A, Seino Y, Hata N, Shimizu W. Features and Outcomes of Patients with Calcified Nodules at Culprit Lesions of Acute Coronary Syndrome: An Optical Coherence Tomography Study. Cardiology 2018; 139:90-100. [DOI: 10.1159/000481931] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 10/02/2017] [Indexed: 11/19/2022]
Abstract
Objectives: We sought to clarify clinical features and outcomes related to calcified nodules (CN) compared with plaque rupture (PR) and plaque erosion (PE) detected by optical coherence tomography (OCT) at the culprit lesions in patients with acute coronary syndrome (ACS). Methods: Based on OCT findings for culprit lesion plaque morphologies, ACS patients with analyzable OCT images (n = 362) were classified as CN, PR, PE, and other. Results: The prevalence of CN, PR, and PE was 6% (n = 21), 45% (n = 163), and 41% (n = 149), respectively. Patients with CN were older (median 71 vs. 65 years, p = 0.03) and more diabetic (71 vs. 35%, p = 0.002) than those without CN. In OCT findings, the distal reference lumen cross-sectional area (median 4.2 vs. 5.2 mm2, p = 0.048) and the postintervention minimum lumen cross-sectional area (median 4.5 vs. 5.3 mm2, p = 0.04) were smaller in lesions with CN than in those without. Kaplan-Meier estimate survival curves showed that the 500-day survival without target lesion revascularization (TLR) was lower (p = 0.011) for patients with CN (72.9%) than for those with PR (89.3%) or PE (94.8%). Conclusions: ACS patients with CN at the culprit lesion had more TLR compared to those with PR or PE.
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Claeys MJ, Sinnaeve PR, Convens C, Dubois P, Pourbaix S, Vranckx P, Gevaert S, De Raedt H, Beauloye C, Argacha JF, Evrard P, Coussement P. Quality assessment in Belgian ST elevation myocardial infarction patients: results from the Belgian STEMI database. Acta Cardiol 2017; 73:1-5. [PMID: 29228878 DOI: 10.1080/00015385.2017.1414344] [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: 10/24/2017] [Accepted: 12/02/2017] [Indexed: 10/18/2022]
Abstract
The present report describes the quality of care, including in hospital mortality for more than 22.000 STEMI patients admitted in 60 Belgian hospitals for the period 2008-2016. We found a strong increase in the use of primary PCI over time, particularly for patients that were admitted first in a non-PCI capable hospital, reaching a penetration rate of >95%. The transition of thrombolysis to transfer for pPCI in the setting of a STEMI network was, however, associated with an increase of the proportion of patients with prolonged (>120 min) diagnosis-to-balloon time (from 16 to 22%), suggesting still suboptimal interhospital transfer. The in-hospital mortality of the total study population was 6.5%. For non-cardiac arrest patients in-hospital mortality decreased from 5.1% to 3.7%, while it increased for cardiac arrest patients from 29 to 37%. The observation that quality indicators (QI's), such as modalities and timing of reperfusion therapy, were associated with lower levels of mortality, underscores the potential of QIs for STEMI to improve care and reduce unwarranted variation and premature death from STEMI.
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Affiliation(s)
- Marc J Claeys
- a Department of Cardiology, University Hospital Antwerp , Edegem , Belgium
| | | | - Carl Convens
- c Department of Cardiology, ZNA Antwerpen , Antwerp , Belgium
| | - Philippe Dubois
- d Department of Cardiology, CHU Charleroi , Charleroi , Belgium
| | - Suzanne Pourbaix
- e Department of Cardiology, CHR Citadelle Liège , Liège , Belgium
| | - Pascal Vranckx
- f Department of Cardiology, Virga Jesse Hasselt , Hasselt , Belgium
| | - Sofie Gevaert
- g Department of Cardiology, UZ Gent , Gent , Belgium
| | - Herbert De Raedt
- h Department of Cardiology, OLV Ziekenhuis Aalst , Aalst , Belgium
| | | | | | - Patrick Evrard
- k Department of Cardiology, UCL Mont-Godinne , Yvoir , Belgium
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Marton-Popovici M. Review. Regional Networks in Acute Cardiac Care. JOURNAL OF CARDIOVASCULAR EMERGENCIES 2017. [DOI: 10.1515/jce-2017-0021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
In acute cardiac care, the timely initiation of life-saving measures proved to be life-saving and requires many organizational and logistic measures. One of such measures is represented by the development and implementation of a regional network dedicated for the treatment of major cardiovascular emergencies, a strategy that proved to significantly reduce mortality rates on short and long term. This review aims to describe the current status in the development of regional networks in three of the main cardiovascular emergencies: acute myocardial infarction, out-of-hospital cardiac arrest, and acute stroke. The concepts demonstrating the utility of such networks, together with their results in reducing cardiac events, are presented in this paper.
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Affiliation(s)
- Monica Marton-Popovici
- Swedish Medical Center, Department of Internal Medicine and Critical Care, Edmonds, Washington , USA
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Welsh RC, Goldstein P, Sinnaeve P, Ostojic MC, Zheng Y, Danays T, Westerhout CM, Van de Werf F, Armstrong PW. Relationship between community hospital versus pre-hospital location of randomisation and clinical outcomes in ST-elevation myocardial infarction patients: insights from the Stream study. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2017. [PMID: 28627230 DOI: 10.1177/2048872617700872] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
AIMS The STREAM study randomly assigned ST-elevation myocardial infarction (STEMI) patients to receive a pharmacoinvasive versus primary percutaneous coronary intervention reperfusion strategy. We assessed whether there was an association between outcomes based on randomisation at a community hospital versus a prehospital location. METHODS/RESULTS Community hospital patients (358/1866 (19.2%)) were compared to prehospital patients and their outcomes categorised into pharmacoinvasive according to their treatment assignment. Compared to prehospital patients, community hospital patients had more diabetes (17.8% vs. 11.5%, P=0.001), higher Killip Class >1 (9.4% vs. 5.0%, P=0.002) and thrombolysis in myocardial infarction risk scores ⩾5 (18.2% vs. 12.4%, P=0.005). The 30-day primary endpoint (death, shock, congestive heart failure and re-infarction) for community hospital patients was 14.9% versus 13.2% for prehospital patients ( P=0.403). Community hospital pharmacoinvasive patients tended to receive less rescue (35.1% vs. 42.8%, P=0.062); when deployed their rescue was delayed 43 minutes. Community hospital patients undergoing primary percutaneous coronary intervention experienced a delay of 31 minutes versus prehospital patients. Pharmacoinvasive patients receiving scheduled angiography from a community hospital and prehospital patients had comparable times to angiography (17.7 vs. 18.7 hours) and low event rates (6.2% vs. 8.0%). Although the interaction between randomisation location and treatment received on the primary endpoint was not significant ( Pinteraction=0.065) those pharmacoinvasive patients requiring rescue from community hospitals had worse outcomes than prehospital rescue patients (odds ratio 2.28, 95% confidence interval 1.16-4.49). CONCLUSION Within STREAM, STEMI patients randomly assigned at community hospitals had a higher baseline risk but similar outcomes compared to those studied prehospital patients irrespective of successful pharmacoinvasive therapy or primary percutaneous coronary intervention. However, worse outcomes in the pharmacoinvasive patients requiring rescue in community hospitals emphasises their need for immediate transfer to a percutaneous coronary intervention-capable hospital.
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Affiliation(s)
- Robert C Welsh
- 1 Canadian VIGOUR Centre and Department of Medicine, University of Alberta, Canada.,2 Mazankowski Alberta Heart Institute, Edmonton, Canada
| | - Patrick Goldstein
- 3 Department and Service d'aide Medicale Urgente, Lille University Hospital, France
| | - Peter Sinnaeve
- 4 Department of Cardiology, University Hospital Gasthuisberg, Belgium
| | | | - Yinggan Zheng
- 1 Canadian VIGOUR Centre and Department of Medicine, University of Alberta, Canada
| | | | - Cynthia M Westerhout
- 1 Canadian VIGOUR Centre and Department of Medicine, University of Alberta, Canada
| | - Frans Van de Werf
- 4 Department of Cardiology, University Hospital Gasthuisberg, Belgium
| | - Paul W Armstrong
- 1 Canadian VIGOUR Centre and Department of Medicine, University of Alberta, Canada
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Li GX, Zhou B, Qi GX, Zhang B, Jiang DM, Wu GM, Ma B, Zhang P, Zhao QR, Li J, Li Y, Shi JP. Current Trends for ST-segment Elevation Myocardial Infarction during the Past 5 Years in Rural Areas of China's Liaoning Province: A Multicenter Study. Chin Med J (Engl) 2017; 130:757-766. [PMID: 28345538 PMCID: PMC5381308 DOI: 10.4103/0366-6999.202742] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background: Since 2010, two versions of National Guidelines aimed at promoting the management of ST-segment elevation myocardial infarction (STEMI) have been formulated by the Chinese Society of Cardiology. However, little is known about the changes in clinical characteristics, management, and in-hospital outcomes in rural areas. Methods: In the present multicenter, cross-sectional study, participants were enrolled from rural hospitals located in Liaoning province in Northeast China, during two different periods (from June 2009 to June 2010 and from January 2015 to December 2015). Data collection was conducted using a standardized questionnaire. In total, 607 and 637 STEMI patients were recruited in the 2010 and 2015 cohorts, respectively. Results: STEMI patients in rural hospitals were older in the second group (63 years vs. 65 years, P = 0.039). We found increases in the prevalence of hypertension, prior percutaneous coronary intervention (PCI), and prior stroke. Over the past 5 years, the cost during hospitalization almost doubled. The proportion of STEMI patients who underwent emergency reperfusion had significantly increased from 42.34% to 54.47% (P < 0.0001). Concurrently, the proportion of primary PCI increased from 3.62% to 10.52% (P < 0.0001). The past 5 years have also seen marked increases in the use of guideline-recommended drugs and clinical examinations. However, in-hospital mortality and major adverse cardiac events did not significantly change over time (13.01% vs. 10.20%, P = 0.121; 13.34% vs. 13.66%, P = 0.872). Conclusions: Despite the great progress that has been made in guideline-recommended therapies, in-hospital outcomes among rural STEMI patients have not significantly improved. Therefore, there is still substantial room for improvement in the quality of care.
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Affiliation(s)
- Guang-Xiao Li
- Department of Clinical Epidemiology, Institute of Cardiovascular Diseases, The First Affiliated Hospital, China Medical University, Shenyang, Liaoning 110001, China
| | - Bo Zhou
- Department of Clinical Epidemiology, Institute of Cardiovascular Diseases, The First Affiliated Hospital, China Medical University, Shenyang, Liaoning 110001, China
| | - Guo-Xian Qi
- Department of Geriatric Cardiology, The First Affiliated Hospital, China Medical University, Shenyang, Liaoning 110001, China
| | - Bo Zhang
- Department of Cardiology, The First Affiliated Hospital, Dalian Medical University, Dalian, Liaoning 116000, China
| | - Da-Ming Jiang
- Department of Cardiology, Dandong Center Hospital, Dandong, Liaoning 118000, China
| | - Gui-Mei Wu
- Department of Special Clinic, The First Affiliated Hospital, China Medical University, Shenyang, Liaoning 110001, China
| | - Bing Ma
- Department of Clinical Epidemiology, Institute of Cardiovascular Diseases, The First Affiliated Hospital, China Medical University, Shenyang, Liaoning 110001, China
| | - Peng Zhang
- Department of Clinical Epidemiology, Institute of Cardiovascular Diseases, The First Affiliated Hospital, China Medical University, Shenyang, Liaoning 110001, China
| | - Qiong-Rui Zhao
- Department of Clinical Epidemiology, Institute of Cardiovascular Diseases, The First Affiliated Hospital, China Medical University, Shenyang, Liaoning 110001, China
| | - Juan Li
- Department of Clinical Epidemiology, Institute of Cardiovascular Diseases, The First Affiliated Hospital, China Medical University, Shenyang, Liaoning 110001, China
| | - Ying Li
- Department of Experiment Teaching Center, School of Public Health, China Medical University, Shenyang, Liaoning 110001, China
| | - Jing-Pu Shi
- Department of Clinical Epidemiology, Institute of Cardiovascular Diseases, The First Affiliated Hospital, China Medical University, Shenyang, Liaoning 110001, China
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Haug B, Rolstad OJ, Vegsundvåg J. [The future PCI treatment after heart attack]. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2016; 136:1612-1613. [PMID: 27790884 DOI: 10.4045/tidsskr.16.0763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Bugiardini R, Badimon L. The International Survey of Acute Coronary Syndromes in Transitional Countries (ISACS-TC): 2010–2015. Int J Cardiol 2016; 217 Suppl:S1-6. [DOI: 10.1016/j.ijcard.2016.06.219] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 06/25/2016] [Indexed: 01/10/2023]
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15
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Mode of admission and its effect on adherence to reperfusion therapy guidelines in Belgian STEMI patients. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2016; 5:461-7. [DOI: 10.1177/2048872616647708] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 03/29/2016] [Indexed: 01/27/2023]
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16
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Jukema JW, Lettino M, Widimský P, Danchin N, Bardaji A, Barrabes JA, Cequier A, Claeys MJ, De Luca L, Dörler J, Erlinge D, Erne P, Goldstein P, Koul SM, Lemesle G, Lüscher TF, Matter CM, Montalescot G, Radovanovic D, Lopez-Sendón J, Tousek P, Weidinger F, Weston CF, Zaman A, Zeymer U. Contemporary registries on P2Y12 inhibitors in patients with acute coronary syndromes in Europe: overview and methodological considerations: Table 1. EUROPEAN HEART JOURNAL - CARDIOVASCULAR PHARMACOTHERAPY 2015; 1:232-244. [DOI: 10.1093/ehjcvp/pvv024] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Tra J, van der Wulp I, de Bruijne MC, Wagner C. Exploring the treatment delay in the care of patients with ST-elevation myocardial infarction undergoing acute percutaneous coronary intervention: a cross-sectional study. BMC Health Serv Res 2015; 15:340. [PMID: 26292969 PMCID: PMC4546199 DOI: 10.1186/s12913-015-0993-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 08/10/2015] [Indexed: 01/14/2023] Open
Abstract
Background A short delay between diagnosis and treatment for patients diagnosed with ST-elevation myocardial infarction (STEMI) is vital to prevent cardiac damage and mortality. The objective of this study was to explore the treatment delay and associated factors in the management of patients diagnosed with STEMI going for percutaneous coronary intervention (PCI). Methods In a cross-sectional multicenter study, the treatment delay (time between first electrocardiogram and start of PCI procedure) of STEMI patients in seven PCI centers in the Netherlands was measured. Data were analyzed by means of multivariable generalized linear models, accounting for a non-normally distributed outcome and clustering of patients within centers. Results In total, 1017 patient charts were included. The majority of the patients (78.7 %) were treated within the guideline recommended time target of 90 min. Overall, the median treatment delay was 64 min (interquartile range 47–82). A significantly prolonged delay was found among patients of whom their first electrocardiogram was performed at a general practitioner’s practice (+23.9 min; 95 % confidence interval 9.9–40.8) or in-hospital (+9.5 min; 95 % confidence interval 2.5–17.3), patients requiring interhospital transfer (+14.6 min; 95 % confidence interval 7.6–22.4) or presenting with acute heart failure on admission (+17.6 min; 95 % confidence interval 7.9–28.7). Conclusions Despite a short median delay between first electrocardiogram and PCI, the time targets are occasionally exceeded for patients diagnosed with STEMI. To further improve the process of care, PCI centers should focus on improving regional STEMI care networks, involving general practitioners, emergency departments and referring hospitals.
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Affiliation(s)
- Joppe Tra
- Department of Public and Occupational Health, EMGO+ / VU University Medical Center, van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
| | - Ineke van der Wulp
- Department of Public and Occupational Health, EMGO+ / VU University Medical Center, van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
| | - Martine C de Bruijne
- Department of Public and Occupational Health, EMGO+ / VU University Medical Center, van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
| | - Cordula Wagner
- Department of Public and Occupational Health, EMGO+ / VU University Medical Center, van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands. .,The Netherlands Institute of Health Services Research (NIVEL), Otterstraat 118, 3513 CR, Utrecht, The Netherlands.
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Alexander T, Victor SM, Mullasari AS, Veerasekar G, Subramaniam K, Nallamothu BK. Protocol for a prospective, controlled study of assertive and timely reperfusion for patients with ST-segment elevation myocardial infarction in Tamil Nadu: the TN-STEMI programme. BMJ Open 2013; 3:e003850. [PMID: 24302505 PMCID: PMC3855601 DOI: 10.1136/bmjopen-2013-003850] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Over the past two decades, India has witnessed a staggering increase in the incidence and mortality of ST-elevation myocardial infarction (STEMI). Indians have higher rates of STEMI and younger populations that suffer from it when compared with developed countries. Yet, the recommended reperfusion therapy with fibrinolysis and percutaneous coronary intervention is available only to a minority of patients. This gap in care is a result of financial barriers, limited healthcare infrastructure and poor knowledge and accessibility of acute medical services for a majority of its population. METHODS AND ANALYSIS This is a prospective, multicentre, 'pretest/post-test' quasi-experimental, community-based study. This programme will use a 'hub-and-spoke' model of an integrated healthcare network based on clusters of primary-care health clinics, small hospitals and large tertiary-care facilities. It is an 'all-comers' study which will enrol consecutive patients presenting with STEMI to the participating hospitals. The primary objectives of the study is to improve the use of reperfusion therapy and reduce the time from first medical contact to device or drug in STEMI patients; and to increase the rates of early invasive risk stratification with coronary angiography within 3-24 h of fibrinolytic therapy in eligible patients through changes in process of care. Outcomes will be measured with statistical comparison made before and after implementing the TN-STEMI programme. The estimated sample size is based on the Kovai Erode Pilot study, which provided an initial work on establishing this type of programme in South India. It will be adequately powered at 80% with a superiority margin of 10% if 36 patients are enrolled per cluster or 108 patients in three clusters. Thus, the enrolment period of 9 months will result in a sample size of 1500 patients. ETHICS This study will be conducted in accordance with the ethical principles that have their origin in the current Declaration of Helsinki and 'ethical guidelines for biomedical research on human participants' as laid down by the Indian Council for Medical Research. All participating hospitals will still obtain local ethics committee approval of the study protocol and written informed consent will be obtained from all participants. DISSEMINATION AND RESULTS Our findings will be reported through scientific publications, research conferences and public policy venues aimed at state and local governments in India. If successful, this model can be extended to other areas of India as well as serve as a model of STEMI systems of care for low-income and middle-income countries across the world. REGISTRATION Trial is registered with Clinical trial registry of India, No: CTRI/2012/09/003002.
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Affiliation(s)
- Thomas Alexander
- Department of Interventional Cardiology, Kovai Medical Center and Hospital, Coimbatore, Tamil Nadu, India
| | - Suma M Victor
- Department of Interventional Cardiology, Madras Medical Mission Hospital, Chennai, Tamil Nadu, India
| | - Ajit S Mullasari
- Department of Interventional Cardiology, Madras Medical Mission Hospital, Chennai, Tamil Nadu, India
| | - Ganesh Veerasekar
- Department of Epidemiology, Kovai Medical Center and Hospital, Coimbatore, Tamil Nadu, India
| | - Kala Subramaniam
- Clinical Research, Lotus Clinical Research Academy Pvt. Ltd, Chennai, Tamil Nadu, India
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Radovanovic D, Nallamothu BK, Seifert B, Bertel O, Eberli F, Urban P, Pedrazzini G, Rickli H, Stauffer JC, Windecker S, Erne P. Temporal trends in treatment of ST-elevation myocardial infarction among men and women in Switzerland between 1997 and 2011. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2013; 1:183-91. [PMID: 24062906 DOI: 10.1177/2048872612454021] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Accepted: 06/16/2012] [Indexed: 11/15/2022]
Abstract
BACKGROUND Few data are available concerning the impact of gender on temporal trends in patients with acute ST-segment elevation myocardial infarction (STEMI). METHODS All STEMI patients consecutively enrolled in the AMIS (Acute Myocardial Infarction in Switzerland) Plus project from 1997-2011 were included. Temporal trends in presentation, treatment and outcomes were analyzed using multiple logistic regressions with generalized estimations. RESULTS Of 21,620 STEMI patients, 5786 were women and 15,834 men from 78 Swiss hospitals. Women were 8.6 years older, presented 48 minutes later with less pain, but more dyspnea, and more frequently had atrial fibrillation (5.5 vs. 3.9%, p<0.001), heart failure (Killip class >2) (9.7 vs. 7.3%, p<0.001), and moderate or severe comorbidities (24.8 vs. 18.2%, p<0.001). Women were less likely to undergo primary reperfusion treatment after adjustment for baseline characteristics and admission year (OR 0.80, 95% CI 0.71-0.90, p<0.001) or receive early and discharge drugs, such as thienopyridines, angiotensin-converting-enzyme inhibitors, angiotensin II receptor antagonists, and statins. In 1997, thrombolysis was performed in 51% of male and 39% of female patients; its use rapidly decreased during the 1990s and has now become negligible. Primary percutaneous coronary intervention increased from under 10% in both genders in 1997 to over 70% in females and over 80% in males since 2006. Patients admitted in cardiogenic shock increased by 8% per year in both genders. The incidence of both reinfarction and cardiogenic shock developing during hospitalization decreased significantly over 15 years while in-hospital mortality decreased from 10 to 5% in men and from 18 to 7% in women. This corresponds to a relative reduction of 5% per year for males (OR 0.95, 95% CI 0.92-0.99, p=0.006) and 6% per year for female STEMI patients (OR 0.94, 95% CI 0.91-0.97, p<0.001). Despite higher crude in-hospital mortality, female gender per se was not an independent predictor of in-hospital mortality (OR 1.07, 95% CI 0.84-1.35, p=0.59). CONCLUSION Substantial changes have occurred in presentation, treatment, and outcome of men and women with STEMI in Switzerland over the past 15 years. Although parallel trends were seen in both groups, ongoing disparities in certain treatments remain. However, these did not translate into worse risk-adjusted in-hospital mortality, suggesting that the gender gap in STEMI care may be closing.
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