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Smith E, Tamis-Holland JE. Sex differences in the presentation and outcomes of patients with acute myocardial infarction complicated by cardiogenic shock: a critical review of contemporary data and a look towards future directions. Curr Opin Crit Care 2024; 30:344-353. [PMID: 38841913 DOI: 10.1097/mcc.0000000000001166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
PURPOSE OF REVIEW Cardiogenic shock (CS) is a devasting complicating of acute myocardial infarction (AMI), associated with significant mortality. Prior studies have reported sex differences in the presentation, management and outcomes of patients with AMI and CS. These differences are likely due to a variety of factors influencing therapeutic decision-making and impacting survival. This review highlights the more contemporary studies exploring differences in women and men with AMI-CS, providing a critical perspective towards understanding the factors that might lead to these differences and outlining potential opportunities to reduce disparities in treatment and improve survival for women with AMI-CS. RECENT FINDINGS Recent reports demonstrate that women with AMI-CS are older than men and have more cardiovascular comorbidities. When examining an unselected population of patients with AMI-CS, women receive less aggressive treatment compared to men and have poorer outcomes. However, when examining a selected population of patients with AMI-CS treated with mechanical circulatory support (MCS) and/or admitted to centers that implement CS protocols to manage AMI-CS, these sex-based differences in outcomes are largely mitigated. SUMMARY Standardizing protocols for the diagnosis and treatment of patients with AMI-CS, with an emphasis on early revascularization and appropriate invasive therapies, can improve outcomes in women and narrow the gender gap.
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Affiliation(s)
- Emily Smith
- Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydnell and Arnold Family Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
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Shan TK, Qian LL, Han XD, Deng B, Gu LF, Wang ZM, He Y, Zhu T, Jing P, Wang QM, Wang ZD, Wang RX, Wang SB, Wang LS. Symptom-to-balloon time and risk of ventricular arrhythmias in patients with STEMI undergoing percutaneous coronary intervention: The VERY-STEMI study. INTERNATIONAL JOURNAL OF CARDIOLOGY. CARDIOVASCULAR RISK AND PREVENTION 2024; 21:200286. [PMID: 38813099 PMCID: PMC11133922 DOI: 10.1016/j.ijcrp.2024.200286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 05/09/2024] [Accepted: 05/12/2024] [Indexed: 05/31/2024]
Abstract
Background Ventricular arrhythmias (VAs) mainly occur in the early post-myocardial infarction (MI) period. However, studies examining the association between total myocardial ischemia time interval and the risk of new-onset VAs during a long-term follow-up are scarce. Methods This study (symptom-to-balloon time and VEntricular aRrhYthmias in patients with STEMI, VERY-STEMI study) was a multicenter, observational cohort and real-world study, which included patients with ST-segment elevation MI (STEMI) undergoing percutaneous coronary intervention (PCI). The primary endpoint was cumulative new-onset VAs during follow-up. The secondary endpoints were the major adverse cardiovascular events (MACE) and changes in left ventricular ejection fraction (ΔLVEF, %). Results A total of 517 patients with STEMI were included and 236 primary endpoint events occurred. After multivariable adjustments, compared to patients with S2BT of 24 h-7d, those with S2BT ≤ 24 h and S2BT > 7d had a lower risk of primary endpoint. RCS showed an inverted U-shaped relationship between S2BT and the primary endpoint, with an S2BT of 68.4 h at the inflection point. Patients with S2BT ≤ 24 h were associated with a lower risk of MACE and a 4.44 increase in LVEF, while there was no significant difference in MACE and LVEF change between the S2BT > 7d group and S2BT of 24 h-7d group. Conclusions S2BT of 24 h-7d in STEMI patients was associated with a higher risk of VAs during follow-up. There was an inverted U-shaped relationship between S2BT and VAs, with the highest risk at an S2BT of 68.4 h.
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Affiliation(s)
- Tian-Kai Shan
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Ling-Ling Qian
- Department of Cardiology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi People's Hospital, Wuxi Medical Center, Nanjing Medical University, Wuxi, 214023, China
| | - Xu-Dong Han
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Bo Deng
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Ling-Feng Gu
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Ze-Mu Wang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Ye He
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Ting Zhu
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Peng Jing
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Qi-Ming Wang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Zi-Dun Wang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Ru-Xing Wang
- Department of Cardiology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi People's Hospital, Wuxi Medical Center, Nanjing Medical University, Wuxi, 214023, China
| | - Si-Bo Wang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Lian-Sheng Wang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
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Zhang LM, Geater AF, McNeil EB, Lin YP, Liu SC, Luo H, Wang YZ, Wen SC. Health Inequalities of STEMI Care Before Implementation of a New Regional Network: A Prefecture-Level Analysis of Social Determinants of Healthcare in Yunnan, China. Int J Health Policy Manag 2022; 11:1413-1424. [PMID: 34060274 PMCID: PMC9808331 DOI: 10.34172/ijhpm.2021.29] [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: 09/27/2020] [Accepted: 03/16/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND As one of the most serious types of coronary heart disease, ST-elevation myocardial infarction (STEMI) faces huge challenges in the equal management and care of patients due to its life-threatening and time-critical condition. Health inequalities such as sex and age differences in STEMI care have been reported from developed countries. However, limited outcomes have been investigated and the major drivers of inequality are still unclear, especially in under-developed areas. This study aimed to explore the major drivers of health inequalities in STEMI care before implementation of a new regional network in the south-west of China. METHODS Prefecture-level data of STEMI patients before the implementation of a regional network were analysed retrospectively. Drivers of inequality were identified from six social determinants of health, namely area of residence, ethnicity, sex, age, education and occupation. Outcomes of STEMI care included timely presentation, reperfusion therapy, timely reperfusion therapy, heart failure, inpatient mortality, length of hospital stay, hospital costs, and various intervals of ischaemic time. RESULTS A total of 376 STEMI patients in the research area before implementation of the STEMI network were included. Compared with urban residents, rural patients were significantly less likely to have timely presentation (odds ratio [OR]=0.47, 95% CI: 0.28-0.80, P=.004) and timely reperfusion therapy (OR=0.32, 95% CI: 0.14-0.70, P=.005). Rural residents were less likely to present to hospital promptly than urban residents (HR=0.65, 95% CI=0.52-0.82, P<.001). In the first 3 hours of percutaneous coronary intervention (PCI) reperfusion delay and first 6 hours of total ischaemic time, rural patients had a significantly lower probability to receive prompt PCI (hazard ratio [HR]=0.40, 95% CI: 0.29-0.54, P<.001) and reperfusion therapy (HR=0.37, 95% CI: 0.25-0.56, P<.001) compared to urban patients. CONCLUSION Rural residents were a major vulnerable group before implementation of the regional STEMI network. No obvious inequalities in ethnicity, sex, age, education or occupation existed in STEMI care in Chuxiong Prefecture of China.
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Affiliation(s)
- Li Mei Zhang
- Department of Cardiology, People’s Hospital of Chuxiong Prefecture, Yunnan, China
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
| | - Alan Frederick Geater
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
| | - Edward B. McNeil
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
| | - Yun Peng Lin
- Department of Cardiology, People’s Hospital of Chuxiong Prefecture, Yunnan, China
| | - Si Chen Liu
- Faculty of Dentistry, Prince of Songkla University, Hat Yai, Thailand
| | - Heng Luo
- People’s Hospital of Chuxiong Prefecture, Yunnan, China
- Executive Office, Alliance of Chuxiong Prefecture Chest Pain Centres, Yunnan, China
| | - Yuan Zhang Wang
- Department of Cardiology, People’s Hospital of Chuxiong Prefecture, Yunnan, China
- Executive Office, Alliance of Chuxiong Prefecture Chest Pain Centres, Yunnan, China
| | - Shao Chang Wen
- Department of Cardiology, People’s Hospital of Chuxiong Prefecture, Yunnan, China
- Executive Office, Alliance of Chuxiong Prefecture Chest Pain Centres, Yunnan, China
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Pre-hospital delay in patients with acute myocardial infarction in China: findings from the Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome (CCC-ACS) project. J Geriatr Cardiol 2022; 19:276-283. [PMID: 35572222 PMCID: PMC9068590 DOI: 10.11909/j.issn.1671-5411.2022.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE To describe the duration of the pre-hospital delay time and identify factors associated with prolonged pre-hospital delay in patients with acute myocardial infarction (AMI) in China. METHODS Data were collected from November 2014 to December 2019 as part of the Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome (CCC-ACS) project. A total of 33,386 patients with AMI admitted to the index hospitals were included in this study. Two-level logistic regression was conducted to explore the factors associated with the pre-hospital delay and the associations between different pre-hospital delay and in-hospital outcomes. RESULTS Of the 33,386 patients with AMI, 70.7% of patients arrived at hospital ≥ 2 h after symptom onset. Old age, female, rural medical insurance, symptom onset at early dawn, and non-use of an ambulance predicted a prolonged pre-hospital delay (all P < 0.05). Hypertension and heart failure at admission were only significant in predicting a longer delay in patients with ST-segment elevation myocardial infarction (STEMI) (all P < 0.05). A pre-hospital delay of ≥ 2 h was associated with an increased risk of mortality [odds ratio (OR) = 1.36, 95% CI: 1.09-1.69, P = 0.006] and major adverse cardiovascular events (OR = 1.22, 95% CI: 1.02-1.47, P = 0.033) in patients with STEMI compared with a pre-hospital delay of < 2 h. CONCLUSIONS Prolonged pre-hospital delay is associated with adverse in-hospital outcomes in patients with STEMI in China. Our study identifies that patient characteristics, symptom onset time, and type of transportation are associated with pre-hospital delay time, and provides focuses for quality improvement.
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Beygui F, Roule V, Ivanes F, Dechery T, Bizeau O, Roussel L, Dequenne P, Arnould MA, Combaret N, Collet JP, Commeau P, Cayla G, Montalescot G, Benamer H, Motreff P, Angoulvant D, Marcollet P, Chassaing S, Blanchart K, Koning R, Rangé G. Indirect Transfer to Catheterization Laboratory for ST Elevation Myocardial Infarction Is Associated With Mortality Independent of System Delays: Insights From the France-PCI Registry. Front Cardiovasc Med 2022; 9:793067. [PMID: 35360033 PMCID: PMC8962625 DOI: 10.3389/fcvm.2022.793067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 02/09/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundFirst medical contact (FMC)-to-balloon time is associated with outcome of ST-elevation myocardial infarction (STEMI). We assessed the impact on mortality and the determinants of indirect vs. direct transfer to the cardiac catheterization laboratory (CCL).MethodsWe analyzed data from 2,206 STEMI patients consecutively included in a prospective multiregional percutaneous coronary intervention (PCI) registry. The primary endpoint was 1-year mortality. The impact of indirect admission to CCL on mortality was assessed using Cox models adjusted on FMC-to-balloon time and covariables unequally distributed between groups. A multivariable logistic regression model assessed determinants of indirect transfer.ResultsA total of 359 (16.3%) and 1847 (83.7%) were indirectly and directly admitted for PCI. Indirect admission was associated with higher risk features, different FMCs and suboptimal pre-PCI antithrombotic therapy.At 1-year follow-up, 51 (14.6%) and 137 (7.7%) were dead in the indirect and direct admission groups, respectively (adjusted-HR 1.73; 95% CI 1.22–2.45). The association of indirect admission with mortality was independent of pre-FMC and FMC characteristics. Older age, paramedics- and private physician-FMCs were independent determinants of indirect admission (adjusted-HRs 1.02 per year, 95% CI 1.003–1.03; 5.94, 95% CI 5.94 3.89–9.01; 3.41; 95% CI 1.86–6.2, respectively).ConclusionsOur study showed that, indirect admission to PCI for STEMI is associated with 1-year mortality independent of FMC to balloon time and should be considered as an indicator of quality of care. Indirect admission is associated with higher-risk features and suboptimal antithrombotic therapy. Older age, paramedics-FMC and self-presentation to a private physician were independently associated with indirect admission. Our study, supports population education especially targeting elderly, more adequately dispatched FMC and improved pre-CCL management.
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Affiliation(s)
- Farzin Beygui
- Cardiology Department, CHU de Caen, Caen, France
- *Correspondence: Farzin Beygui
| | | | | | - Thierry Dechery
- Cardiology Department, Center Hospitalier de Bourges, Bourges, France
| | | | - Laurent Roussel
- Cardiology Department, Les Hôpitaux de Chartres, Chartres, France
| | | | - Marc-Antoine Arnould
- Cardiology Department, Nouvelle clinique Tourangelle, Saint-Cyr-sur-Loire, France
| | - Nicolas Combaret
- Cardiology Department, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | | | - Philippe Commeau
- Cardiology Department, Polyclinique les fleurs, Ollioules, France
| | | | - Gilles Montalescot
- Cardiology Department, Groupe hospitalier Pitié-Salpêtrière, Paris, France
| | - Hakim Benamer
- Cardiology Department, Clinique de la Roseraie, Aubervilliers, France
| | - Pascal Motreff
- Cardiology Department, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | | | - Pierre Marcollet
- Cardiology Department, Center Hospitalier de Bourges, Bourges, France
| | - Stephan Chassaing
- Cardiology Department, Nouvelle clinique Tourangelle, Saint-Cyr-sur-Loire, France
| | | | - René Koning
- Cardiology Department, Clinique Saint Hilaire, Saint Hilaire, France
| | - Grégoire Rangé
- Cardiology Department, Les Hôpitaux de Chartres, Chartres, France
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6
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Ericsson M, Thylén I, Strömberg A, Ängerud KH, Moser DK, Sederholm Lawesson S. Factors associated with patient decision time in ST-segment elevation myocardial infarction, in early and late responders-an observational cross-sectional survey study. Eur J Cardiovasc Nurs 2022; 21:694-701. [PMID: 35165735 DOI: 10.1093/eurjcn/zvab124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 11/05/2021] [Accepted: 11/24/2021] [Indexed: 11/14/2022]
Abstract
AIMS A short time span from symptom onset to reperfusion is imperative in ST-segment elevation myocardial infarction (STEMI). The aim of this study was to determine factors associated with patient decision time for seeking care in STEMI, particularly how symptoms were experienced and affected patient response. METHODS AND RESULTS A multicentre cross-sectional self-report survey study was completed at five Swedish hospitals representing geographic diversity. The 521 patients were divided into three groups based on their time to respond to symptoms: early (<20 min), intermediate (20-90 min), and late responders (>90 min). Only one out of five patients both responded early and called an ambulance within 20 min. Believing symptoms were cardiac in origin [odds ratio (OR) 2.60], male sex (OR 2.40), left anterior descending artery as culprit artery (OR 1.77), and bystanders calling an ambulance (OR 4.32) were factors associated with early response and correct action. Associated symptoms such as dyspnoea (OR 1.67) and weakness (OR 1.65) were associated with an early action (<20 min), while chest pain was not independently associated with response time. Cold sweat (OR 0.61) prevented late care-seeking behaviour as did a high symptom burden (OR 0.86). CONCLUSION Misinterpretation of symptoms delays correct care-seeking behaviour because patient expectations may not be aligned with the experience when stricken by Myocardial infarction. Therefore, it is imperative to continuously enhance public awareness in correct symptom recognition and appropriate care-seeking behaviour and to make efforts to educate individuals at risk for STEMI as well as their next of kin.
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Affiliation(s)
- Maria Ericsson
- Department of Cardiology, Linköping University, 581 85 Linköping, Sweden.,Department of Health, Medical and Caring Sciences, Linköping University, 581 85 Linköping, Sweden
| | - Ingela Thylén
- Department of Cardiology, Linköping University, 581 85 Linköping, Sweden.,Department of Health, Medical and Caring Sciences, Linköping University, 581 85 Linköping, Sweden
| | - Anna Strömberg
- Department of Cardiology, Linköping University, 581 85 Linköping, Sweden.,Department of Health, Medical and Caring Sciences, Linköping University, 581 85 Linköping, Sweden
| | - Karin H Ängerud
- Cardiology, Heart Centre, Department of Nursing, Umeå University, Umeå, Sweden
| | - Debra K Moser
- College of Nursing, University of Kentucky, Lexington, KY, USA
| | - Sofia Sederholm Lawesson
- Department of Cardiology, Linköping University, 581 85 Linköping, Sweden.,Department of Health, Medical and Caring Sciences, Linköping University, 581 85 Linköping, Sweden
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7
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Weininger D, Cordova JP, Wilson E, Eslava DJ, Alviar CL, Korniyenko A, Bavishi CP, Hong MK, Chorzempa A, Fox J, Tamis-Holland JE. Delays to Hospital Presentation in Women and Men with ST-Segment Elevation Myocardial Infarction: A Multi-Center Analysis of Patients Hospitalized in New York City. Ther Clin Risk Manag 2022; 18:1-9. [PMID: 35018099 PMCID: PMC8742618 DOI: 10.2147/tcrm.s335219] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 10/23/2021] [Indexed: 11/29/2022] Open
Abstract
Purpose Previous studies have shown longer delays from symptom onset to hospital presentation (S2P time) in women than men with acute myocardial infarction. The aim of this study is to understand the reasons for delays in seeking care among women and men presenting with an ST-Segment Elevation Myocardial Infarction (STEMI) through a detailed assessment of the thoughts, perceptions and patterns of behavior. Patients/Methods and Results A total of 218 patients with STEMI treated with primary angioplasty at four New York City Hospitals were interviewed (24% female; Women: 68.7 ± 13.1 years and men: 60.7 ± 13.8 years) between January 2009 and August 2012. A significantly larger percentage of women than men had no chest pain (62% vs 36%, p<0.01). Compared to men, a smaller proportion of women thought they were having a myocardial infarction (15% vs 34%, p=0.01). A larger proportion of women than men had S2P time >90 minutes (72% of women vs 54% of men, p= 0.03). Women were more likely than men to hesitate before seeking help, and more women than men hesitated because they did not think they were having an AMI (91% vs 83%, p=0.04). Multivariate regression analysis showed that female sex (Odds Ratio: 2.46, 95% CI 1.10–5.60 P=0.03), subjective opinion it was not an AMI (Odds Ratio 2.44, 95% CI 1.20–5.0, P=0.01) and level of education less than high school (Odds ratio 7.21 95% CI 1.59–32.75 P=0.01) were independent predictors for S2P >90 minutes. Conclusion Women with STEMI have longer pre-hospital delays than men, which are associated with a higher prevalence of atypical symptoms and a lack of belief in women that they are having an AMI. Greater focus should be made on educating women (and men) regarding the symptoms of STEMI, and the importance of a timely response to these symptoms.
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Affiliation(s)
| | | | | | | | - Carlos L Alviar
- NYU Medical Center and Bellevue Hospital Center, New York, NY, USA
| | | | | | - Mun K Hong
- Bassett Healthcare Network, Cooperstown, NY, USA
| | | | - John Fox
- Mount Sinai Beth Israel Hospital, New York, NY, USA
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8
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The relationship between symptom onset-to-needle time and ischemic outcomes in patients with acute myocardial infarction treated with primary PCI: Observations from Prague-18 Study. J Cardiol 2021; 79:626-633. [PMID: 34924237 DOI: 10.1016/j.jjcc.2021.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 10/21/2021] [Accepted: 11/04/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Based on previous studies with clopidogrel, the time between acute myocardial infarction (AMI) symptoms onset and primary percutaneous coronary intervention (PCI) was proven as important prognostic factor. Our aim was to assess the relationship between symptoms onset to needle time (SNT) and procedural results and the occurrence of ischemic endpoints in primary angioplasty patients treated with potent P2Y12 inhibitors. METHODS A total of 1,131 out of 1,230 patients randomized to the Prague-18 study (prasugrel vs. ticagrelor in primary PCI) were divided into a high and a low-risk group. The effect of defined SNT on patients' ischemic endpoints and prognosis by their risk status at admission was tested. RESULTS The median SNT was 3.2 hours. Longer SNTs resulted in a more frequent incidence of TIMI flow <3 post PCI (p=0.015). There were significant differences in the occurrence of the combined ischemic endpoint among the compared SNT groups at 30 days (p=0.032), and 1 year (p=0.011), with the highest incidence in the ≤1 h SNT group of patients. "Latecomers" (SNT>4 hs) in the high-risk group experienced more reinfarction within 1 year [OR (95% CI) 3.23 (1.09-9.62) p=0.035]; no difference was found in the low-risk group. CONCLUSIONS In the era of intense antithrombotic medication, stratification of MI patients undergoing primary angioplasty, based on initial ischemic risk assessment affected prognosis more than symptom onset to needle time. Longer time delay was significantly related to increased incidence of ischemic events and all-cause mortality only in patients with high ischemic risk.
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9
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Lux A, Vainer J, Theunissen RALJ, Veenstra LF, Kasperski I, Gho BCG, Stein M, Ilhan M, Ruiters AW, Winkler PJC, van Beurden A, Dohmen W, Rasoul S, van 't Hof AWJ. Sharing primary percutaneous coronary intervention care: first experiences with South Limburg ST-elevation myocardial infarction network. Neth Heart J 2021; 29:348-353. [PMID: 33534114 PMCID: PMC8160048 DOI: 10.1007/s12471-021-01541-2] [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] [Accepted: 01/14/2021] [Indexed: 12/03/2022] Open
Abstract
Background In the region of South Limburg, the Netherlands, a shared ST-elevation myocardial infarction (STEMI) networking system (SLIM network) was implemented. During out-of-office hours, two percutaneous coronary intervention (PCI) centres—Maastricht University Medical Centre and Zuyderland Medical Centre—are supported by the same interventional cardiologist. The aim of this study was to analyse performance indicators within this network and to compare them with contemporary European Society of Cardiology guidelines. Methods Key time indicators for an all-comer STEMI population were registered by the emergency medical service and the PCI centres. The time measurements showed a non-Gaussian distribution; they are presented as median with 25th and 75th percentiles. Results Between 1 February 2018 and 31 March 2019, a total of 570 STEMI patients were admitted to the participating centres. The total system delay (from emergency call to needle time) was 65 min (53–77), with a prehospital system delay of 40 min (34–47) and a door-to-needle time of 22 min (15–34). Compared with in-office hours, out-of-office hours significantly lengthened system delays (55 (47–66) vs 70 min (62–81), p < 0.001), emergency medical service transport times (29 (24–34) vs 35 min (29–40), p < 0.001) and door-to-needle times (17 (14–26) vs 26 min (18–37), p < 0.001). Conclusions With its effective patient pathway management, the SLIM network was able to meet the quality criteria set by contemporary European revascularisation guidelines.
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Affiliation(s)
- A Lux
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands. .,Heart+Vascular Center, Maastricht University Medical Centre, Maastricht, The Netherlands.
| | - J Vainer
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.,Heart+Vascular Center, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - R A L J Theunissen
- Heart+Vascular Center, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - L F Veenstra
- Heart+Vascular Center, Maastricht University Medical Centre, Maastricht, The Netherlands.,Department of Cardiology, Zuyderland Medical Centre, Heerlen, The Netherlands
| | - I Kasperski
- Department of Cardiology, Zuyderland Medical Centre, Heerlen, The Netherlands
| | - B C G Gho
- Department of Cardiology, Zuyderland Medical Centre, Heerlen, The Netherlands
| | - M Stein
- Department of Cardiology, Zuyderland Medical Centre, Heerlen, The Netherlands
| | - M Ilhan
- Heart+Vascular Center, Maastricht University Medical Centre, Maastricht, The Netherlands.,Department of Cardiology, Zuyderland Medical Centre, Heerlen, The Netherlands
| | - A W Ruiters
- Department of Cardiology, Zuyderland Medical Centre, Heerlen, The Netherlands
| | - P J C Winkler
- Heart+Vascular Center, Maastricht University Medical Centre, Maastricht, The Netherlands.,Department of Cardiology, Zuyderland Medical Centre, Heerlen, The Netherlands
| | - A van Beurden
- Department of Medical Management, Municipal Health Services South Limburg, Heerlen, The Netherlands
| | - W Dohmen
- Heart+Vascular Center, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - S Rasoul
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.,Department of Cardiology, Zuyderland Medical Centre, Heerlen, The Netherlands
| | - A W J van 't Hof
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.,Heart+Vascular Center, Maastricht University Medical Centre, Maastricht, The Netherlands.,Department of Cardiology, Zuyderland Medical Centre, Heerlen, The Netherlands
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10
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Jäger B, Haller PM, Piackova E, Kaff A, Christ G, Schreiber W, Weidinger F, Stefenelli T, Delle-Karth G, Maurer G, Huber K. Predictors of transportation delay in patients with suspected ST-elevation-myocardial infarction in the VIENNA-STEMI network. Clin Res Cardiol 2020; 109:393-399. [PMID: 31256260 PMCID: PMC7042186 DOI: 10.1007/s00392-019-01520-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 06/24/2019] [Indexed: 11/03/2022]
Abstract
OBJECTIVE The emergency medical service (EMS) provides rapid pre-hospital diagnosis and transportation in ST-elevation myocardial infarction (STEMI) systems of care. Aim of the study was to assess temporal and regional characteristics of EMS-related delays in a metropolitan STEMI network. METHODS Patient call-to-arrival of EMS at site (call-to-site), transportation time from site to hospital (site-to-door), call-to-door, patient's location, month, weekday, and hour of EMS activation were recorded in 4751 patients referred to a tertiary center with suspicion of STEMI. RESULTS Median call-to-site, site-to-door, and call-to-door times were 9 (7-12), 39 (31-48), and 49 (41-59) minutes, respectively. The shortest transportation times were noted between 08:00 and 16:00 and in general on Sundays. They were significantly prolonged between midnight and 04:00, whereby the longest difference did not exceed 4 min in median. Patient's site of call had a major impact on transportation times, which were shorter in Central and Western districts as compared to Southern and Eastern districts of Vienna (p < 0.001 between-group difference for call-to-site, site-to-door, and call-to-door). After multivariable adjustment, patient's site of call was an independent predictor of call-to-site delay (p < 0.001). Moreover, age and hour of EMS activation were the strongest predictors of call-to-site, site-to-door, and call-to-door delays (p < 0.05). CONCLUSION In our Viennese STEMI network, the strongest determinants of pre-hospital EMS-related transportation delays were patient's site of call, patient's age, and hour of EMS activation. Due to the significant but small median time delays, which are within the guideline-recommended time intervals, no impact on clinical outcome can be expected.
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Affiliation(s)
- Bernhard Jäger
- 3rd Medical Department, Cardiology and Intensive Care Medicine, Wilhelminen Hospital, Montleartstrasse 35-37, 1160, Vienna, Austria.
- Medical Faculty, Sigmund Freud Private University, Vienna, Austria.
- Medical University of Vienna, Vienna, Austria.
| | - Paul Michael Haller
- 3rd Medical Department, Cardiology and Intensive Care Medicine, Wilhelminen Hospital, Montleartstrasse 35-37, 1160, Vienna, Austria
| | - Edita Piackova
- 3rd Medical Department, Cardiology and Intensive Care Medicine, Wilhelminen Hospital, Montleartstrasse 35-37, 1160, Vienna, Austria
| | | | - Günter Christ
- 5th Medial Department, Cardiology, Sozialmedizinsiches Zentrum Süd - Kaiser-Franz-Josef-Spital, Vienna, Austria
| | - Wolfgang Schreiber
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Franz Weidinger
- 2nd Medical Department, Cardiology, Krankenhaus Rudolfstiftung, Vienna, Austria
| | - Thomas Stefenelli
- 1st Medical Department, Cardiology, Sozialmedizinisches Zentrum Ost, Vienna, Austria
| | - Georg Delle-Karth
- 4th Medical Department, Cardiology, Krankenhaus Hietzing, Vienna, Austria
| | - Gerhard Maurer
- Department of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Kurt Huber
- 3rd Medical Department, Cardiology and Intensive Care Medicine, Wilhelminen Hospital, Montleartstrasse 35-37, 1160, Vienna, Austria
- Medical Faculty, Sigmund Freud Private University, Vienna, Austria
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11
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Lee SH, Kim HK, Jeong MH, Lee JM, Gwon HC, Chae SC, Seong IW, Park JS, Chae JK, Hur SH, Cha KS, Kim HS, Seung KB, Rha SW, Ahn TH, Kim CJ, Hwang JY, Choi DJ, Yoon J, Joo SJ, Hwang KK, Kim DI, Oh SK. Pre-hospital delay and emergency medical services in acute myocardial infarction. Korean J Intern Med 2020; 35:119-132. [PMID: 31766823 PMCID: PMC6960059 DOI: 10.3904/kjim.2019.123] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 06/19/2019] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS Minimising total ischemic time (TIT) is important for improving clinical outcomes in patients with ST-segment elevation myocardial infarction who have undergone percutaneous coronary intervention (PCI). TIT has not shown a significant improvement due to persistent pre-hospital delay. This study aimed to investigate the risk factors associated with pre-hospital delay. METHODS Individuals enrolled in the Korea Acute Myocardial Infarction Registry-National Institutes of Health between 2011 and 2015 were included in this study. The study population was analyzed according to the symptom-to-door time (STDT; within 60 or > 60 minutes), and according to the type of hospital visit (emergency medical services [EMS], non-PCI center, or PCI center). RESULTS A total of 4,874 patients were included in the analysis, of whom 28.4% arrived at the hospital within 60 minutes of symptom-onset. Old age (> 65 years), female gender, and renewed ischemia were independent predictors of delayed STDT. Utilising EMS was the only factor shown to reduce STDT within 60 minutes, even when cardiogenic shock was evident. The overall frequency of EMS utilisation was low (21.7%). Female gender was associated with not utilising EMS, whereas cardiogenic shock, previous myocardial infarction, familial history of ischemic heart disease, and off-hour visits were associated with utilising EMS. CONCLUSION Factors associated with delayed STDT and not utilising EMS could be targets for preventive intervention to improve STDT and TIT.
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Affiliation(s)
- Seung Hun Lee
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
- Heart Vascular and Stroke Institute, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyun Kuk Kim
- Department of Cardiology, Chosun University Hospital, Gwangju, Korea
| | - Myung Ho Jeong
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
- Correspondence to Myung Ho Jeong, M.D. Department of Cardiology, Chonnam National University Hospital, 42 Jebong-ro, Donggu, Gwangju 61469, Korea Tel: +82-62-220-6243, Fax: +82-62-228-7174, E-mail:
| | - Joo Myung Lee
- Heart Vascular and Stroke Institute, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyeon-Cheol Gwon
- Heart Vascular and Stroke Institute, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Shung Chull Chae
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - In-Whan Seong
- Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Jong-Seon Park
- Division of Cardiology, Yeungnam University Medical Centre, Daegu, Korea
| | - Jei Keon Chae
- Division of Cardiology, Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Korea
| | - Seung-Ho Hur
- Department of Cardiovascular Medicine, Keimyung University Dongsan Medical Centre, Daegu, Korea
| | - Kwang Soo Cha
- Department of Cardiology, Pusan National University Hospital, Busan, Korea
| | - Hyo-Soo Kim
- Cardiovascular Centre, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Ki-Bae Seung
- Division of Cardiology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seung-Woon Rha
- Cardiovascular Centre, Korea University Guro Hospital, Seoul, Korea
| | - Tae Hoon Ahn
- Department of Cardiology, Gachon University Gil Medical Center, Incheon, Korea
| | - Chong-Jin Kim
- Department of Cardiology, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Jin-Yong Hwang
- Department of Internal Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Dong-Ju Choi
- Cardiovascular Centre, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Junghan Yoon
- Division of Cardiology, Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Seung-Jae Joo
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Kyung-Kuk Hwang
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Doo-Il Kim
- Department of Internal Medicine, Inje University Haeundae Paik Hospital, Busan, Korea
| | - Seok Kyu Oh
- Division of Cardiology, Department of Internal Medicine, Wonkwang University School of Medicine, Iksan, Korea
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12
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Calé R, Pereira H, Pereira E, Vitorino S, de Mello S. Time to reperfusion in high-risk patients with myocardial infarction undergoing primary percutaneous coronary intervention. Rev Port Cardiol 2019; 38:637-646. [DOI: 10.1016/j.repc.2018.12.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 11/06/2018] [Accepted: 12/02/2018] [Indexed: 12/01/2022] Open
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13
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Calé R, Pereira H, Pereira E, Vitorino S, de Mello S. Time to reperfusion in high-risk patients with myocardial infarction undergoing primary percutaneous coronary intervention. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2019. [DOI: 10.1016/j.repce.2019.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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14
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Ventura M, Belleudi V, Sciattella P, Di Domenicantonio R, Di Martino M, Agabiti N, Davoli M, Fusco D. High quality process of care increases one-year survival after acute myocardial infarction (AMI): A cohort study in Italy. PLoS One 2019; 14:e0212398. [PMID: 30785928 PMCID: PMC6382131 DOI: 10.1371/journal.pone.0212398] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 02/03/2019] [Indexed: 11/19/2022] Open
Abstract
Background The relationship between guideline adherence and outcomes in patients with acute myocardial infarction (AMI) has been widely investigated considering the emergency, acute, post-acute phases separately, but the effectiveness of the whole care process is not known. Aim The study aim was to evaluate the effect of the multicomponent continuum of care on 1-year survival after AMI. Methods We conducted a cohort study selecting all incident cases of AMI from health information systems during 2011–2014 in the Lazio region. Patients’ clinical history was defined by retrieving previous hospitalizations and drugs prescriptions. For each subject the probability to reach the hospital and the conditional probabilities to survive to 30 days from admission and to 31–365 days post discharge were estimated through multivariate logistic models. The 1-year survival probability was calculated as the product of the three probabilities. Quality of care indicators were identified in terms of emergency timeliness (time between residence and the nearest hospital), hospital performance in treatment of acute phase (number/timeliness of PCI on STEMI) and drug therapy in post-acute phase (number of drugs among antiplatelet, β-blockers, ACE inhibitors/ARBs, statins). The 1-year survival Probability Ratio (PR) and its Bootstrap Confidence Intervals (BCI) between who were exposed to the highest level of quality of care (timeliness<10', hospitalization in high performance hospital, complete drug therapy) and who exposed to the worst (timeliness≥10', hospitalization in low performance hospital, suboptimal drug therapy) were calculated for a mean-severity patient and varying gender and age. PRs for patients with diabetes and COPD were also evaluated. Results We identified 38,517 incident cases of AMI. The out-of-hospital mortality was 27.6%. Among the people arrived in hospital, 42.9% had a hospitalization for STEMI with 11.1% of mortality in acute phase and 5.4% in post-acute phase. For a mean-severity patient the PR was 1.19 (BCI 1.14–1.24). The ratio did not change by gender, while it moved from 1.06 (BCI 1.05–1.08) for age<65 years to 1.62 (BCI 1.45–1.80) for age >85 years. For patients with diabetes and COPD a slight increase in PRs was also observed. Conclusions The 1-year survival probability post AMI depends strongly on the quality of the whole multicomponent continuum of care. Improving the performance in the different phases, taking into account the relationship among these, can lead to considerable saving of lives, in particular for the elderly and for subjects with chronic diseases.
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Affiliation(s)
- Martina Ventura
- Department of Epidemiology of Lazio Regional Health Service, Rome, Italy
| | - Valeria Belleudi
- Department of Epidemiology of Lazio Regional Health Service, Rome, Italy
| | - Paolo Sciattella
- Department of Statistical Sciences, “Sapienza” University of Rome, Rome, Italy
| | | | - Mirko Di Martino
- Department of Epidemiology of Lazio Regional Health Service, Rome, Italy
| | - Nera Agabiti
- Department of Epidemiology of Lazio Regional Health Service, Rome, Italy
- * E-mail:
| | - Marina Davoli
- Department of Epidemiology of Lazio Regional Health Service, Rome, Italy
| | - Danilo Fusco
- Department of Epidemiology of Lazio Regional Health Service, Rome, Italy
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15
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McNair PW, Bilchick KC, Keeley EC. Very late presentation in ST elevation myocardial infarction: Predictors and long-term mortality. IJC HEART & VASCULATURE 2019; 22:156-159. [PMID: 30828600 PMCID: PMC6383163 DOI: 10.1016/j.ijcha.2019.02.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 02/03/2019] [Indexed: 01/17/2023]
Abstract
Background Despite improvements in ST elevation myocardial infarction (STEMI) care, total ischemic time remains long in patients who present late. Our goal was to identify predictors of very late presentation (≥12 h) of STEMI and determine long-term mortality. Methods We retrospectively examined consecutive patients admitted with STEMI to our institution using the ACTION Registry™. Time of symptom onset to first medical contact (FMC) was calculated and categorized as <12 h or ≥12 h. Predictors of very late presentation were determined. Results Compared to patients who presented <12 h (n = 365), those who presented ≥12 h (n = 49) after symptom onset were more likely women, diabetics, and those with prior coronary revascularization. In addition, patients who presented ≥12 h had worse ventricular function, were less likely to report chest pain, and were less likely to be transported by ambulance and to undergo coronary angiography. Late presenters had higher rates of heart failure, longer hospitalizations, and were less likely to be discharged home. Diabetes, female sex, and absence of chest pain were strong predictors of late presentation. Long-term survival was significantly lower in late presenters (73% vs. 93%, p = 0.007). Conclusions Female sex, diabetes, and absence of chest pain are strong predictors of presentation delay, and long-term mortality is significantly increased in those presenting very late. A proportion of patients with acute myocardial infarction present late after symptom onset. Women, diabetics and patients who do not experience typical chest pain are more likely to present late. Patients with myocardial infarction who present late have increased mortality at one year.
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Affiliation(s)
- Patrick W McNair
- Department of Medicine, Division of Cardiology, University of Virginia, Charlottesville, VA, United States of America
| | - Kenneth C Bilchick
- Department of Medicine, Division of Cardiology, University of Virginia, Charlottesville, VA, United States of America
| | - Ellen C Keeley
- Department of Medicine, Division of Cardiovascular Medicine, University of Florida, Gainesville, FL, United States of America
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16
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Meyer MR, Bernheim AM, Kurz DJ, O’Sullivan CJ, Tüller D, Zbinden R, Rosemann T, Eberli FR. Gender differences in patient and system delay for primary percutaneous coronary intervention: current trends in a Swiss ST-segment elevation myocardial infarction population. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2018; 8:283-290. [DOI: 10.1177/2048872618810410] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background: Women with ST-segment elevation myocardial infarction (STEMI) experience greater delays for percutaneous coronary intervention-facilitated reperfusion than men. Whether women and men benefit equally from current strategies to reduce ischaemic time and whether there are gender differences in factors determining delays is unclear. Methods: Patient delay (symptom onset to first medical contact) and system delay (first medical contact to percutaneous coronary intervention-facilitated reperfusion) were compared between women ( n=967) and men ( n=3393) in a Swiss STEMI treatment network. Trends from 2000 to 2016 were analysed, with additional comparisons between three time periods (2000–2005, 2006–2011 and 2012–2016). Factors predicting delays and hospital mortality were determined by multivariate regression modelling. Results: Female gender was independently associated with greater patient delay ( P=0.02 vs. men), accounting for a 12% greater total ischaemic time among women in 2012–2016 (median 215 vs. 192 minutes, P<0.001 vs. men). From 2000–2005 to 2012–2016, median system delay was reduced by 18 and 25 minutes in women and men, respectively ( P<0.0001 for trend, P=n.s. for gender difference). Total occlusion of the culprit artery, stent thrombosis, a Killip class of 3 or greater, and presentation during off-hours predicted delays in men, but not in women. A Killip class of 3 or greater and age, but not gender or delays, were independently associated with hospital mortality. Conclusions: STEMI-related ischaemic time in women remains greater than in men due to persistently greater patient delays. In contrast to men, clinical signs of ongoing chest discomfort do not predict delays in women, suggesting that female STEMI patients are less likely to attribute symptoms to a condition requiring urgent treatment.
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Affiliation(s)
- Matthias R Meyer
- Division of Cardiology, Triemli Hospital, Zurich, Switzerland
- Institute of Primary Care, University of Zurich, Switzerland
| | | | - David J Kurz
- Division of Cardiology, Triemli Hospital, Zurich, Switzerland
| | | | - David Tüller
- Division of Cardiology, Triemli Hospital, Zurich, Switzerland
| | - Rainer Zbinden
- Division of Cardiology, Triemli Hospital, Zurich, Switzerland
| | - Thomas Rosemann
- Institute of Primary Care, University of Zurich, Switzerland
| | - Franz R Eberli
- Division of Cardiology, Triemli Hospital, Zurich, Switzerland
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17
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Rodrigues JA, Melleu K, Schmidt MM, Gottschall CAM, Moraes MAPD, Quadros ASD. Independent Predictors of Late Presentation in Patients with ST-Segment Elevation Myocardial Infarction. Arq Bras Cardiol 2018; 111:587-593. [PMID: 30281695 PMCID: PMC6199504 DOI: 10.5935/abc.20180178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 05/09/2018] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND In patients with acute ST-segment elevation myocardial infarction (STEMI), the time elapsed from symptom onset to receiving medical care is one of the main mortality predictors. OBJECTIVE To identify independent predictors of late presentation in patients STEMI representative of daily clinical practice. METHODS All patients admitted with a diagnosis of STEMI in a reference center between December 2009 and November 2014 were evaluated and prospectively followed during hospitalization and for 30 days after discharge. Late presentation was defined as a time interval > 6 hours from chest pain onset until hospital arrival. Multiple logistic regression analysis was used to identify independent predictors of late presentation. Values of p < 0.05 were considered statistically significant. RESULTS A total of 1,297 patients were included, with a mean age of 60.7 ± 11.6 years, of which 71% were males, 85% Caucasians, 72% had a mean income lower than five minimum wages and 66% had systemic arterial hypertension. The median time of clinical presentation was 3.00 [1.40-5.48] hours, and approximately one-quarter of the patients had a late presentation, with their mortality being significantly higher. The independent predictors of late presentation were Black ethnicity, low income and diabetes mellitus, and a history of previous heart disease was a protective factor. CONCLUSION Black ethnicity, low income and diabetes mellitus are independent predictors of late presentation in STEMI. The identification of subgroups of patients prone to late presentation may help to stimulate prevention policies for these high-risk individuals.
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Affiliation(s)
- Juliane Araujo Rodrigues
- Instituto de Cardiologia / Fundação Universitária de Cardiologia - IC/FUC, Porto Alegre, RS - Brazil
| | - Karina Melleu
- Instituto de Cardiologia / Fundação Universitária de Cardiologia - IC/FUC, Porto Alegre, RS - Brazil
| | - Márcia Moura Schmidt
- Instituto de Cardiologia / Fundação Universitária de Cardiologia - IC/FUC, Porto Alegre, RS - Brazil
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18
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Gender differences in short- and long-term mortality in the Vienna STEMI registry. Int J Cardiol 2017; 244:303-308. [DOI: 10.1016/j.ijcard.2017.05.068] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Revised: 04/24/2017] [Accepted: 05/16/2017] [Indexed: 01/15/2023]
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Fabris E, van ’t Hof A, Hamm CW, Lapostolle F, Lassen JF, Goodman SG, ten Berg JM, Bolognese L, Cequier A, Chettibi M, Hammett CJ, Huber K, Janzon M, Merkely B, Storey RF, Zeymer U, Cantor WJ, Tsatsaris A, Kerneis M, Diallo A, Vicaut E, Montalescot G. Clinical impact and predictors of complete ST segment resolution after primary percutaneous coronary intervention: A subanalysis of the ATLANTIC Trial. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2017; 8:208-217. [DOI: 10.1177/2048872617727722] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background: In the ATLANTIC (Administration of Ticagrelor in the catheterization laboratory or in the Ambulance for New ST elevation myocardial Infarction to open the Coronary artery) trial the early use of aspirin, anticoagulation, and ticagrelor coupled with very short medical contact-to-balloon times represent good indicators of optimal treatment of ST-elevation myocardial infarction and an ideal setting to explore which factors may influence coronary reperfusion beyond a well-established pre-hospital system. Methods: This study sought to evaluate predictors of complete ST-segment resolution after percutaneous coronary intervention in ST-elevation myocardial infarction patients enrolled in the ATLANTIC trial. ST-segment analysis was performed on electrocardiograms recorded at the time of inclusion (pre-hospital electrocardiogram), and one hour after percutaneous coronary intervention (post-percutaneous coronary intervention electrocardiogram) by an independent core laboratory. Complete ST-segment resolution was defined as ≥70% ST-segment resolution. Results: Complete ST-segment resolution occurred post-percutaneous coronary intervention in 54.9% ( n=800/1456) of patients and predicted lower 30-day composite major adverse cardiovascular and cerebrovascular events (odds ratio 0.35, 95% confidence interval 0.19–0.65; p<0.01), definite stent thrombosis (odds ratio 0.18, 95% confidence interval 0.02–0.88; p=0.03), and total mortality (odds ratio 0.43, 95% confidence interval 0.19–0.97; p=0.04). In multivariate analysis, independent negative predictors of complete ST-segment resolution were the time from symptoms to pre-hospital electrocardiogram (odds ratio 0.91, 95% confidence interval 0.85–0.98; p<0.01) and diabetes mellitus (odds ratio 0.6, 95% confidence interval 0.44–0.83; p<0.01); pre-hospital ticagrelor treatment showed a favorable trend for complete ST-segment resolution (odds ratio 1.22, 95% confidence interval 0.99–1.51; p=0.06). Conclusions: This study confirmed that post-percutaneous coronary intervention complete ST-segment resolution is a valid surrogate marker for cardiovascular clinical outcomes. In the current era of ST-elevation myocardial infarction reperfusion, patients’ delay and diabetes mellitus are independent predictors of poor reperfusion and need specific attention in the future.
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Affiliation(s)
- Enrico Fabris
- Cardiology Department, Isala Heart Center, the Netherlands
- Cardiovascular Department, University of Trieste, Italy
| | - Arnoud van ’t Hof
- Cardiology Department, Isala Heart Center, the Netherlands
- Department of Cardiology, Maastricht University Medical Center, the Netherlands
- Department of Cardiology, Zuyderland Hospital, the Netherlands
| | | | | | - Jens F Lassen
- Department of Cardiology B, Aarhus University Hospital, Denmark
| | - Shaun G Goodman
- Canadian Heart Research Centre, University of Toronto, Canada
| | - Jurriën M ten Berg
- Department of Cardiology, St Antonius Hospital Nieuwegein, the Netherlands
| | - Leonardo Bolognese
- Cardiovascular and Neurological Department, Azienda Ospedaliera Arezzo, Italy
| | - Angel Cequier
- Heart Disease Institute, University of Barcelona, Spain
| | | | | | - Kurt Huber
- Cardiology and Intensive Care Medicine, Wilhelminen Hospital, Austria
- Sigmund Freud Private University, Austria
| | - Magnus Janzon
- Department of Cardiology, Linköping University, Sweden
- Department of Medical and Health Sciences, Linköping University, Sweden
| | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, Hungary
| | - Robert F Storey
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, UK
| | - Uwe Zeymer
- Klinikum Ludwigshafen and Institut für Herzinfarktforschung, Germany
| | - Warren J Cantor
- Southlake Regional Health Centre, University of Toronto, Canada
| | | | | | | | - Eric Vicaut
- ACTION Study Group, Hospital Lariboisiere, France
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20
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Impact of age on short- and long-term mortality of patients with ST-elevation myocardial infarction in the VIENNA STEMI network. Wien Klin Wochenschr 2017; 130:172-181. [DOI: 10.1007/s00508-017-1250-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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21
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Tateishi K, Abe D, Iwama T, Hamabe Y, Aonuma K, Sato A. Clinical value of ST-segment change after return of spontaneous cardiac arrest and emergent coronary angiography in patients with out-of-hospital cardiac arrest: Diagnostic and therapeutic importance of vasospastic angina. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2017; 7:405-413. [DOI: 10.1177/2048872617722486] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background: We investigated the association between initial ST-segment change after return of spontaneous circulation (ROSC) and the incidence of acute coronary lesions in patients with out-of-hospital cardiac arrest (OHCA), and clinical outcomes of patients with OHCA caused by vasospastic angina pectoris (VSA). Methods: Among 2779 OHCA patients in our institution, all patients with ROSC underwent emergent coronary angiography (CAG) except for those with an obvious extra-cardiac cause of OHCA. Initial ST-segment changes after ROSC were reviewed, and 30-day survival and neurological outcome (Cerebral Performance Category) were evaluated. Results: Of the 155 patients, 52 (34%) had ST-segment elevation (STE) and 103 (66%) had non-STE. Significant coronary culprit lesions were present in 81% of patients with STE and in 33% of patients with non-STE ( P<.001). Percutaneous coronary intervention (PCI) was successful in 60 patients (93.8%) and failed in 4 patients (6.2%). Among 155 patients, 74 patients (47.7%) had favorable neurological prognosis, and 104 patients (67.1%) were alive at 30 days. ST-segment analysis showed good positive predictive value (81%) but low negative predictive value (68%) in diagnosing the presence of acute coronary lesions. VSA was found in 5 patients (9.6%) in the STE group and in 12 patients (11.7%) in the non-STE group. Of these 17 patients, 9 (52.9%) had favorable neurological outcome and 14 (82.4%) were alive at 30 days. Conclusion: An acute culprit lesion may be the cause of OHCA even in the absence of STE. In survivors of OHCA with normal coronary arteries, spasm provocation testing should be performed to detect VSA as a cause of the arrest.
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Affiliation(s)
- Kazuya Tateishi
- Department of Cardiology, Tokyo Metropolitan Bokutoh Hospital, Japan
| | - Daisuke Abe
- Department of Cardiology, Tokyo Metropolitan Bokutoh Hospital, Japan
| | - Tooru Iwama
- Department of Cardiology, Tokyo Metropolitan Bokutoh Hospital, Japan
| | - Yuichi Hamabe
- Emergency and Intensive Care Center, Tokyo Metropolitan Bokutoh Hospital, Japan
| | - Kazutaka Aonuma
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Japan
| | - Akira Sato
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Japan
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Nielsen CGA, Laut KG, Jensen LO, Ravkilde J, Terkelsen CJ, Kristensen SD. Patient delay in patients with ST-elevation myocardial infarction: Time patterns and predictors for a prolonged delay. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2016; 6:583-591. [DOI: 10.1177/2048872616676570] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Kristina G Laut
- Department of Cardiology, Aarhus University Hospital, Denmark
| | | | - Jan Ravkilde
- Department of Cardiology, Aalborg University Hospital, Denmark
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23
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De Luca L, Marini M, Gonzini L, Boccanelli A, Casella G, Chiarella F, De Servi S, Di Chiara A, Di Pasquale G, Olivari Z, Caretta G, Lenatti L, Gulizia MM, Savonitto S. Contemporary Trends and Age-Specific Sex Differences in Management and Outcome for Patients With ST-Segment Elevation Myocardial Infarction. J Am Heart Assoc 2016; 5:e004202. [PMID: 27881426 PMCID: PMC5210417 DOI: 10.1161/jaha.116.004202] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 10/07/2016] [Indexed: 01/12/2023]
Abstract
BACKGROUND Age- and sex-specific differences exist in the treatment and outcome of ST-elevation myocardial infarction (STEMI). We sought to describe age- and sex-matched contemporary trends of in-hospital management and outcome of patients with STEMI. METHODS AND RESULTS We analyzed data from 5 Italian nationwide prospective registries, conducted between 2001 and 2014, including consecutive patients with STEMI. All the analyses were age- and sex-matched, considering 4 age classes: <55, 55 to 64, 65 to 74, and ≥75 years. A total of 13 235 patients were classified as having STEMI (72.1% men and 27.9% women). A progressive shift from thrombolysis to primary percutaneous coronary intervention occurred over time, with a concomitant increase in overall reperfusion rates (P for trend <0.0001), which was consistent across sex and age classes. The crude rates of in-hospital death were 3.2% in men and 8.4% in women (P<0.0001), with a significant increase over age classes for both sexes and a significant decrease over time for both sexes (all P for trend <0.01). On multivariable analysis, age (odds ratio 1.09, 95% CI 1.07-1.10, P<0.0001) and female sex (odds ratio 1.44, 95% CI 1.07-1.93, P=0.009) were found to be significantly associated with in-hospital mortality after adjustment for other risk factors, but no significant interaction between these 2 variables was observed (P for interaction=0.61). CONCLUSIONS Despite a nationwide shift from thrombolytic therapy to primary percutaneous coronary intervention for STEMI affecting both sexes and all ages, women continue to experience higher in-hospital mortality than men, irrespective of age.
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Affiliation(s)
- Leonardo De Luca
- Division of Cardiology, San Giovanni Evangelista Hospital, Tivoli (Rome), Italy
| | - Marco Marini
- Department of Cardiovascular Sciences, Ospedali Riuniti, Ancona, Italy
| | | | | | - Gianni Casella
- Department of Cardiology, Maggiore Hospital, Bologna, Italy
| | - Francesco Chiarella
- Division of Cardiology, Azienda Ospedaliera-Universitaria S. Martino, Genova, Italy
| | - Stefano De Servi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Antonio Di Chiara
- Division of Cardiology, Ospedale Sant'Antonio Abate, Tolmezzo, Italy
| | | | - Zoran Olivari
- Department of Cardiology, Ca' Foncello Hospital, Treviso, Italy
| | - Giorgio Caretta
- Division of Cardiology, Sant'Andrea Hospital, ASL 5 Liguria, La Spezia, Italy
| | - Laura Lenatti
- Division of Cardiology, Ospedale A. Manzoni, Lecco, Italy
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