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Kirigaya J, Matsuzawa Y, Ebina T, Abe T, Iwahashi N, Fukui K, Maeda A, Akashi Y, Ako J, Ikari Y, Namiki A, Michishita I, Sugano T, Tamura K, Hibi K, Kimura K, Suzuki H. Benefit of prehospital electrocardiogram on door-to-device time in ST-segment elevation myocardial infarction with cardiogenic shock: Data from the Kanagawa Acute Cardiovascular Registry. J Cardiol 2024:S0914-5087(24)00156-4. [PMID: 39153660 DOI: 10.1016/j.jjcc.2024.08.004] [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: 02/29/2024] [Revised: 07/30/2024] [Accepted: 08/08/2024] [Indexed: 08/19/2024]
Abstract
BACKGROUND The benefit of prehospital 12‑lead electrocardiogram (PH-ECG) performed by emergency medical service personnel at the site of first medical contact (FMC) in patients with ST-segment elevation myocardial infarction (STEMI) with cardiogenic shock (CS-STEMI) remains unclear. This study aimed to investigate the effect of PH-ECG on door-to-device time in patients with CS-STEMI. METHODS This study enrolled CS-STEMI (Killip class IV) patients who were transferred directly to hospitals by ambulance (n = 517) from the Kanagawa Acute Cardiovascular Registry database. Patients were divided into PH-ECG (+) (n = 270) and PH-ECG (-) (n = 247) groups. Patients who experienced out-of-hospital cardiac arrest, who did not undergo emergent coronary intervention, or whose data were missing were excluded. Patient characteristics, FMC-to-door time, door-to-device time, and in-hospital mortality were compared between the groups. RESULTS The patient backgrounds of the PH-ECG (+) and PH-ECG (-) groups were comparable. The peak creatinine kinase level was greater in the PH-ECG (+) group than in the PH-ECG (-) group [2756 (1292-6009) IU/ml vs. 2270 (957-5258) IU/ml, p = 0.048]. The FMC-to-door time was similar between the two groups [25 (20-33) min vs. 27 (20-35) min, p = 0.530], while the door-to-device time was significantly shorter in the PH-ECG group [74 (52-103) min vs. 83 (62-111) min, p = 0.007]. In-hospital mortality did not differ between the two groups (18 % vs. 21 %, p = 0.405). Multivariable logistic regression analyses revealed that PH-ECG (+) was independently associated with a door-to-device time < 60 min [odds ratio (95 % confidence intervals): 1.88 (1.24-2.83), p = 0.003]. CONCLUSIONS PH-ECG was significantly associated with shorter door-to-device times in patients with CS-STEMI. Further studies with larger populations and more defined protocols are required to evaluate the utility of PH-ECG in patients with CS-STEMI.
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Affiliation(s)
- Jin Kirigaya
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Yasushi Matsuzawa
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
| | - Toshiaki Ebina
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Takeru Abe
- Integrated Center for Science and Humanities, Fukushima Medical University Medical Center, Fukushima, Japan
| | - Noriaki Iwahashi
- Department of Cardiology, Yokohama City University School of Medicine, Yokohama, Japan
| | - Kazuki Fukui
- Division of Cardiology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan
| | - Atsuo Maeda
- Department of Emergency and Disaster Medicine, Showa University School of Medicine, Yokohama, Japan
| | - Yoshihiro Akashi
- Division of Cardiology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Junya Ako
- Division of Cardiology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Yuji Ikari
- Division of Cardiology, Tokai University School of Medicine, Isehara, Japan
| | - Atsuo Namiki
- Division of Cardiology, Kanto Rosai Hospital, Kawasaki, Japan
| | - Ichiro Michishita
- Division of Cardiology, Yokohama Sakae Kyosai Hospital, Yokohama, Japan
| | - Teruyasu Sugano
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Kouichi Tamura
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Kiyoshi Hibi
- Department of Cardiology, Yokohama City University School of Medicine, Yokohama, Japan
| | - Kazuo Kimura
- Department of Cardiovascular Medicine, Yokosuka City Hospital, Yokosuka, Japan
| | - Hiroshi Suzuki
- Division of Cardiology, Showa University Fujigaoka Hospital, Yokohama, Japan
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Yufu K, Shimomura T, Kawano K, Sato H, Yonezu K, Saito S, Kondo H, Fukui A, Akioka H, Shinohara T, Teshima Y, Abe R, Takahashi N. Usefulness of Prehospital 12-Lead Electrocardiography System in ST-Segment Elevation Myocardial Infarction Patients in Oita - Comparison Between Urban and Rural Areas, Weekday Daytime and Weekday Nighttime/Holidays. Circ J 2024; 88:1293-1301. [PMID: 37612071 DOI: 10.1253/circj.cj-23-0365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
BACKGROUND We have reported that a prehospital 12-lead electrocardiography system (P-ECG) contributed to transport of suspected acute coronary syndrome (ACS) patients to appropriate institutes and in this study, we compared its usefulness between urban and rural areas, and between weekday daytime and weekday nighttime/holiday. METHODS AND RESULTS Consecutive STEMI patients who underwent successful primary percutaneous coronary intervention after using P-ECG were assigned to the P-ECG group (n=123; 29 female, 70±13 years), and comparable STEMI patients without using P-ECG were assigned to the conventional group (n=117; 33 females, mean age 70±13 years). There was no significant difference in door-to-reperfusion times between the rural and urban cases (70±32 vs. 69±29 min, P=0.73). Door-to-reperfusion times in the urban P-ECG group were shorter than those in the urban conventional group for weekday nighttime/holiday (65±21 vs. 83±32 min, P=0.0005). However, there was no significance different between groups for weekday daytime. First medical contact to reperfusion time (90±22 vs. 105±37 min, P=0.0091) in the urban P-ECG group were significantly shorter than in the urban conventional groups for weekday nighttime/holiday, but were not significantly different between the groups for weekday daytime. CONCLUSIONS P-ECG is useful even in urban areas, especially for patients who develop STEMI during weekday nighttime or while on a holiday.
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Affiliation(s)
- Kunio Yufu
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University
| | | | - Kyoko Kawano
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University
| | - Hiroki Sato
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University
| | - Keisuke Yonezu
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University
| | - Shotaro Saito
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University
| | - Hidekazu Kondo
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University
| | - Akira Fukui
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University
| | - Hidefumi Akioka
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University
| | - Tetsuji Shinohara
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University
| | - Yasushi Teshima
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University
| | - Ryuzo Abe
- Advanced Trauma Emergency and Critical Care Center, Oita University Hospital
| | - Naohiko Takahashi
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University
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Sarrafzadegan N, Bagherikholenjani F, Shahidi S, Ghasemi G, Shirvani E, Rajati F, Najafi F, Ghaffari S, Khosravi A, Assareh A, Adel SMH, Kojuri J, Samiei N, Masoudkabir F, Farshidi H, Kermani-Alghoraishi M, Sadeghi M, Shafei D, Jorjani M, Siavash M, Khorvash F, Isfahani MN, Fatemi B, Davari M, Moradinia M, Hoseinkhani R, Hajhashemi V, Mohammadifard N, Mobarhan MG, Momeni A, Mortazavi M, Akbari M, Sattar F, Noohi F, Kheiri M, Tabatabaeilotfi M, Bakhshandeh S, Janjani P, Fakhri S, Abdi A. Development of the first Iranian clinical practice guidelines for the diagnosis, treatment, and secondary prevention of acute coronary syndrome. JOURNAL OF RESEARCH IN MEDICAL SCIENCES : THE OFFICIAL JOURNAL OF ISFAHAN UNIVERSITY OF MEDICAL SCIENCES 2024; 29:32. [PMID: 39239072 PMCID: PMC11376720 DOI: 10.4103/jrms.jrms_851_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 02/20/2024] [Accepted: 03/04/2024] [Indexed: 09/07/2024]
Abstract
Background This article introduces the first national guidelines for the management including diagnosis, treatment, and secondary prevention of acute coronary syndrome (ACS) in Iran. Materials and Methods The members of the guideline development group (GDG) were specialists and experts in fields related to ACS and were affiliated with universities of medical sciences or scientific associations in the country. They carefully examined the evidence and clinical concerns related to ACS management and formulated 13 clinical questions that were sent to systematic review group who developed related evidence using Grade method. Finally the GDG developed the recommendations and suggestions of the guideline. Results The first three questions in the guideline focus on providing recommendations for handling a patient who experience chest pain at home, in a health house or center, during ambulance transportation, and upon arrival at the emergency department (ED) as well as the initial diagnostic measures in the ED. Subsequently, the recommendations related to the criteria for categorizing patients into low, intermediate and high-risk groups are presented. The guideline addressed primary treatment measures for ACS patients in hospitals with and without code 247 or having primary percutaneous coronary intervention (PCI) facilities, and the appropriate timing for PCI based on the risk assessment. In addition, the most efficacious antiplatelet medications for ACS patients in the ED as well as its optimal duration of treatment are presented. The guideline details the recommendations for therapeutic interventions in patients with ACS and acute heart failure, cardiogenic shock, myocardial infarction with nonobstructive coronary arteries (MINOCA), multivessel occlusion, as well as the indication for prescribing a combined use of anticoagulants and antiplatelet during hospitalization and upon discharge. Regarding secondary prevention, while emphasizing the referral of these patients to rehabilitation centers, other interventions that include pharmaceutical and nonpharmacological ones are addressed, In addition, necessary recommendations for enhancing lifestyle and posthospital discharge pharmaceutical treatments, including their duration, are provided. There are specific recommendations and suggestions for subgroups, such as patients aged over 75 years and individuals with heart failure, diabetes, and chronic kidney disease. Conclusion Developing guidelines for ACS diagnosis, treatment and secondary prevention according to the local context in Iran can improve the adherence of our health care providers, patients health, and policy makers plans.
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Affiliation(s)
- Nizal Sarrafzadegan
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
- Iranian Network of Cardiovascular Research, Tehran, Iran
| | - Fahimeh Bagherikholenjani
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shahla Shahidi
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Golsa Ghasemi
- Isfahan Kidney Disease Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ehsan Shirvani
- Iranian Network of Cardiovascular Research, Tehran, Iran
- Interventional Cardiology Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fatemeh Rajati
- Department of Health Education and Health Promotion, School of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Farid Najafi
- Research Center for Environmental Determinants of Health, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Samad Ghaffari
- Iranian Network of Cardiovascular Research, Tehran, Iran
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Alireza Khosravi
- Iranian Network of Cardiovascular Research, Tehran, Iran
- Hypertension Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ahmadreza Assareh
- Iranian Network of Cardiovascular Research, Tehran, Iran
- Atherosclerosis Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Seyed Mohammad Hassan Adel
- Iranian Network of Cardiovascular Research, Tehran, Iran
- Department of Cardiology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Javad Kojuri
- Iranian Network of Cardiovascular Research, Tehran, Iran
- Department of Cardiovascular Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Niloufar Samiei
- Iranian Network of Cardiovascular Research, Tehran, Iran
- Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Farzad Masoudkabir
- Iranian Network of Cardiovascular Research, Tehran, Iran
- Cardiac Primary Prevention Research Center, Cardiovascular Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Farshidi
- Iranian Network of Cardiovascular Research, Tehran, Iran
- Cardiovascular Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Mohammad Kermani-Alghoraishi
- Iranian Network of Cardiovascular Research, Tehran, Iran
- Interventional Cardiology Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Masoumeh Sadeghi
- Iranian Network of Cardiovascular Research, Tehran, Iran
- Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Davood Shafei
- Iranian Network of Cardiovascular Research, Tehran, Iran
- Heart Failure Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Masoumeh Jorjani
- Department of Pharmacology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mansour Siavash
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fariborz Khorvash
- Isfahan Neurosciences Research Center, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mehdi Nasr Isfahani
- Department of Emergency Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Behzad Fatemi
- Department of Pharmacoeconomics and Pharmaceutical Administration, Pharmaceutical Management and Economic Research Center, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Majid Davari
- Department of Pharmacoeconomics and Pharmaceutical Administration, Pharmaceutical Management and Economic Research Center, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Mitra Moradinia
- Physician of Community Health Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ramesh Hoseinkhani
- Deputy of Public Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Valiollah Hajhashemi
- Department of Pharmacology and Toxicology, School of Pharmacy and Pharmaceutical Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Noushin Mohammadifard
- Pediatric Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Majid Ghayour Mobarhan
- Iranian UNESCO Center of Excellence for Human Nutrition, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Momeni
- Department of Internal Medicine, School of Medical Science, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Mojgan Mortazavi
- Isfahan Kidney Disease Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Akbari
- Department of Mental Health Nursing, Nursing and Midwifery Care Research Center, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fereshteh Sattar
- Cardiology Department, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Fereidoun Noohi
- Iranian Network of Cardiovascular Research, Tehran, Iran
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Maryam Kheiri
- Department of Health, Ministry of Health and Medical Education, Tehran, Iran
| | - Mosa Tabatabaeilotfi
- Department of Treatment, Development of Standard and Clinical Practice Guideline Group, Ministry of Health and Medical Education, Tehran, Iran
| | - Sanaz Bakhshandeh
- Department of Treatment, Development of Standard and Clinical Practice Guideline Group, Ministry of Health and Medical Education, Tehran, Iran
| | - Parisa Janjani
- Cardiovascular Research Center, Health Institute, Imam-Ali Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Sajad Fakhri
- Pharmaceutical Sciences Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Alireza Abdi
- Department of Emergency and Critical Care Nursing, Faculty of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Brunetti ND, Curcio A, Nodari S, Parati G, Carugo S, Molinari M, Acquistapace F, Gensini G, Molinari G. The Italian Society of Cardiology and Working Group on Telecardiology and Informatics 2023 updated position paper on telemedicine and artificial intelligence in cardiovascular disease. J Cardiovasc Med (Hagerstown) 2023; 24:e168-e177. [PMID: 37186567 DOI: 10.2459/jcm.0000000000001447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
In 2015, the Italian Society of Cardiology and its Working Group on Telemedicine and Informatics issued a position paper on Telecardiology, resuming the most eminent evidence supporting the use of information and communication technology in principal areas of cardiovascular care, ranked by level of evidence. More than 5 years later and after the global shock inflicted by the SARS-CoV-2 pandemic, an update on the topic is warranted. Recent evidence and studies on principal areas of cardiovascular disease will be therefore reported and discussed, with particular focus on telemedicine for cardiovascular care in the COVID-19 context. Novel perspectives and opportunities disclosed by artificial intelligence and its applications in cardiovascular disease will also be discussed. Finally, modalities by which machine learning have realized remote patient monitoring and long-term care in recent years, mainly filtering critical clinical data requiring selective hospital admission, will be provided.
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Affiliation(s)
- Natale D Brunetti
- Division of Cardiology, Department of Medical & Surgical Sciences, University of Foggia, Foggia
| | - Antonio Curcio
- Division of Cardiology, Department of Medical and Surgical Sciences, University 'Magna Graecia' of Catanzaro, Catanzaro
| | - Savina Nodari
- Dept. of Medical and Surgical Specialities, Radiological Sciences and Public Health-University of Brescia Medical School
- University of Brescia Medical School, Brescia
| | | | - Stefano Carugo
- Department of Clinical Sciences and Community Health
- Cardiology Unit, Dept. of Internal Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore, University of Milan, Milan
| | - Martina Molinari
- Department of Cardiology, Ospedale 'P.A. Micone', ASL 3 Genovese, Genoa, Italy
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