Change to a primary PCI program increases number of patients offered reperfusion therapy and significantly reduces mortality

2008 ◽  
Vol 127 (2) ◽  
pp. 208-213 ◽  
Author(s):  
Alf Inge Larsen ◽  
Tor H. Melberg ◽  
Vernon Bonarjee ◽  
Ståle Barvik ◽  
Dennis W.T. Nilsen
Keyword(s):  
Reperfusion Therapy ◽  
Primary Pci ◽  
Number Of Patients

scholarly journals Comorbidity index for predicting mortality at 6 months after reperfusion therapy

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Hyo Suk Nam ◽  
Young Dae Kim ◽  
Joonsang Yoo ◽  
Hyungjong Park ◽  
Byung Moon Kim ◽  
...  
Keyword(s):  
Prospective Cohort ◽  
Multivariate Logistic Regression Analysis ◽  
Area Under The Curve ◽  
Reperfusion Therapy ◽  
Good Prediction ◽  
Multivariate Logistic Regression ◽  
Stroke Patients ◽  
Number Of Patients ◽  
Comorbidity Index ◽  
Using Data

AbstractThe eligibility of reperfusion therapy has been expanded to increase the number of patients. However, it remains unclear the reperfusion therapy will be beneficial in stroke patients with various comorbidities. We developed a reperfusion comorbidity index for predicting 6-month mortality in patients with acute stroke receiving reperfusion therapy. The 19 comorbidities included in the Charlson comorbidity index were adopted and modified. We developed a statistical model and it was validated using data from a prospective cohort. Among 1026 patients in the retrospective nationwide reperfusion therapy registry, 845 (82.3%) had at least one comorbidity. As the number of comorbidities increased, the likelihood of mortality within 6 months also increased (p < 0.001). Six out of the 19 comorbidities were included for developing the reperfusion comorbidity index on the basis of the odds ratios in the multivariate logistic regression analysis. This index showed good prediction of 6-month mortality in the retrospective cohort (area under the curve [AUC], 0.747; 95% CI, 0.704–0.790) and in 333 patients in the prospective cohort (AUC, 0.784; 95% CI, 0.709–0.859). Consideration of comorbidities might be helpful for the prediction of the 6-month mortality in patients with acute ischemic stroke who receive reperfusion therapy.

scholarly journals Impact of coronary intensive care unit in treatment of myocardial infarction

2017 ◽  
Vol 63 (3) ◽  
pp. 242-247
Author(s):  
Marcia Cristina Todo ◽  
Carolina Marabesi Bergamasco ◽  
Paula Schmidt Azevedo ◽  
Marcos Ferreira Minicucci ◽  
Roberto Minoru Tanni Inoue ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Intensive Care ◽  
Angiotensin Converting Enzyme ◽  
Enzyme Inhibitors ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Reperfusion Therapy ◽  
Converting Enzyme ◽  
Converting Enzyme Inhibitors ◽  
St Segment Elevation ◽  
Number Of Patients

Summary Introduction: The mortality rate attributed to ST-segment elevation myocardial infarction (STEMI) has decreased in the world. However, this disease is still responsible for high costs for health systems. Several factors could decrease mortality in these patients, including implementation of cardiac intensive care units (CICU). The aim of this study was to evaluate the effect of CICU implementation on prescribed recommended treatments and mortality 30 days after STEMI. Method: We performed a retrospective study with patients admitted to CICU between 2005 and 2006 (after group) and between 2000 and 2002, before CICU implementation (before group). Results: The after group had 101 patients, while the before group had 143 patients. There were no differences in general characteristics between groups. We observed an increase in angiotensin-converting enzyme inhibitors, clopidogrel and statin prescriptions after CICU implementation. We did not find differences regarding number of patients submitted to reperfusion therapy; however, there was an increase in primary percutaneous angioplasty compared with thrombolytic therapy in the after group. There was no difference in 30-day mortality (before: 10.5%; after: 8.9%; p=0.850), but prescription of recommended treatments was high in both groups. Prescription of angiotensin-converting enzyme inhibitors and beta-blocker decreased mortality risk by 4.4 and 4.9 times, respectively. Conclusion: CICU implementation did not reduce mortality after 30 days in patients with STEMI; however, it increased the prescription of standard treatment for these patients.

Results of treatment of myocardial infarction with ST-segment elevation using early and delayed coronary interventions in different age groups

2021 ◽  
pp. 8-12
Author(s):  
G. A. Gazaryan ◽  
G. A. Nefedova ◽  
L. G. Tyurina ◽  
I. V. Zakharov ◽  
A. S. Ermolov
Keyword(s):  
Disease Onset ◽  
Age Groups ◽  
Reperfusion Therapy ◽  
Primary Pci ◽  
St Segment Elevation ◽  
Results Of Treatment ◽  
Proximal Lesion ◽  
St Segment ◽  
Artery Disease ◽  
Timi Risk Score

The aim of the study was to assess the treatment results in patients with anterior STEMI using primary PCI in different patient age groups, including those at late hospitalization, taking into account the initial mortality risk (MR). The study included 804 patients with anterior STEMI, aged 28 to 91 years, who were admitted to N. V. Sklifosovsky Research Institute for Emergency Medicine in the period from 2008 to 2017: 583 of them had the primary PCI performed either within the first 12 hours from the disease onset (311 patients) or at late hospitalization: after 12–72 hours (272 patients); and 221 patients treated without PCI. The distribution of patients by age: under 65 years old, 65–75 years old, and over 75 years old was 340, 139, and 104 in the PCI group, and 126, 47, and 48 in the group without PCI, respectively. In 26 death cases after PCI and in 39 of died without interventions, the state of the coronary bed, the affected area, and the immediate cause of death were determined. We have found that in the absence of reperfusion therapy (RT) in STEMI, the initially high baseline MR assessed by TIMI Risk Score corresponds to high mortality. It affects people of predominantly elderly and, especially, senile age, who more often have a proximal lesion of the main coronary arteries, which causes an extensive area of infarction with the development of fatal complications. The use of primary PCIs, including those at late hospitalization, prevents the progression of acute heart failure, the formation of LV aneurysms, and reduces the deaths rate. In different periods of time, the mortality rate with the use of primary PCI, including the delayed ones, fluctuates; it can rise with a significantly increasing number of the hospitalized at senile age. An increase in mortality is associated with complications, including those arising during procedures in severe multivessel coronary artery disease, which is more common in this patient population. Achieving angiographic success even in the absence of ECG signs of reperfusion can significantly reduce mortality in all age groups. High MR is an optimal indication for using delayed procedures. An urgent use of primary PCIs, including those at late hospitalization, allows the optimization of the STEMI treatment, and the achievement of the maximum reduction in mortality.

scholarly journals ST elevation myocardial infarction equivalent - De Winter T-wave electrocardiography pattern

2018 ◽  
Vol 71 (7-8) ◽  
pp. 265-269
Author(s):  
Igor Ivanov ◽  
Anastazija Stojsic-Milosavljevic ◽  
Vladimir Ivanovic ◽  
Milos Trajkovic ◽  
Aleksandra Vulin ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Reperfusion Therapy ◽  
Proper Treatment ◽  
Anterior Myocardial Infarction ◽  
St Segment Elevation ◽  
T Wave ◽  
St Segment ◽  
Number Of Patients ◽  
St Elevation

Introduction. Rapid diagnosis of acute myocardial infarction is essential for proper treatment and reduction of patient mortality. Electrocardiography plays an important role in its diagnosis. Acute myocardial infarction with ST segment elevation requires urgent reperfusion therapy, that is, primary percutaneous coronary revascularization. A small number of patients with acute myocardial infarction have ST segment depression in one or more leads, whereas ST segment elevation in augmented vector right the electrocardiogram is characteristic for a myocardial infarction without ST elevation, but the clinical course and the severity of disease correspond to the anterior myocardial infarction with ST segment elevation. De Winter T-wave electrocardiography. One of these forms is known as de Winter T-wave pattern, characterized by ST segment depression at the J-point (> 1 mm) in the precordial leads, the absence of ST segment elevation in the precordial leads, high peaked and symmetrical T-waves in the precordial leads and, in most cases, mild ST segment elevation (0.5 mm to 1 mm) in the augmented vector right. These patients have occlusion of the left main coronary artery, occlusion of the proximal segment of the anterior descending artery, or a severe multivessel coronary disease. Patients with this electrocardiographic pattern, which is equivalent to acute myocardial infarction with ST segment elevation, require consideration of emergency reperfusion therapy due to high mortality, compared to other patients with acute myocardial infarction without ST elevation. Primary percutaneous intervention is recommended, or if there is no catheterization laboratory nearby, fibrinolytic therapy may be considered. Because of the lack of clear recommendations, treatment decisions are made individually, from case to case. Conclusion. We need large pro?spective studies with this specific electrocardiographic pattern to provide quick recognition and proper treatment of the anterior myocardial infarction with ST elevation.

scholarly journals Primary PCI for STEMI Patients: Has Patient’s Access and Hospital Outcome Improved over the Last 5 Years

2018 ◽  
Vol 3 (10) ◽  
Keyword(s):  
Hospital Mortality ◽  
Public Awareness ◽  
Reperfusion Therapy ◽  
Late Presentation ◽  
Direct Access ◽  
Primary Pci ◽  
Apparent Lack ◽  
St Segment Elevation ◽  
Hospital Outcome ◽  
Evidenced Based

Background: Reperfusion therapy by Primary PCI in ST-segment elevation myocardial infarction (STEMI result in great benefit than from fibrin lytic therapy, The fast access to PPCI will improve hospital outcome, We believe that patient access to PPCI facility would have improved due to improved public awareness and expanding evidenced-based health provision. Method: This is a retrospective study to analyze and compare data for STEMI patients during 2010 (Group l = 223 pts) and those treated between August 2014 and August 2015 (Group 2 = 288 pts). We compared demographic and baseline characteristics, patient’s access, reason for no access and hospital mortality for the two groups. Results: Among the 288 patients in G2, 247 patients (85%) were males with average age of 57 yrs. 49% were diabetics, 48% hypertensive, 48% were smokers and 27% were obese. These were not different in G1. Of G2, 164 pts (57%) only had access to PPCI compared to 56% in G1 (p = 0.536-NS). In G2, the main reasons for no PPCI was late presentation in 47% vs 53% in G1; P = 0.34-NS and 27% due to thrombolysis vs 17% in G1 (p = 0.11NS). Hospital mortality in G2 was 4% in those treated with PPCI compared to 2.3% in Gi (P = 0.522-NS). Mortality In pts who did not receive PPCI in G2 was 8% compared to 11.3% in G1 (p = 0.49-NS). Females in G2 have about 3 times higher mortality. Compared to 2010, pts treated for STEMI in the last 12 months at KACC still have same, relatively low access to pPCI due mainly to persistent pattern of late presentation and prior thrombolysis which reflect apparent lack of direct access to hospitals with PPCI facilities. Conclusion: Comparing the two periods there was no change in the practice, the low access to PPCI was mainly due to late presentation and Prior thrombolysis, Hospital mortality rate for patients treated with PPCI remained low during the two eras, this seemingly relates to both lack of public awareness and health provision factors in PPCI organizations.

scholarly journals Contrast Induced Nephropathy and its predictors after Primary Percutaneous Intervention

2021 ◽  
Vol 18 (2) ◽  
pp. 27-31
Author(s):  
Krishna Chandra Adhikari ◽  
Rabi Malla ◽  
Arun Maskey ◽  
Sujeeb Rajbhandari ◽  
Bishow Raj Baral ◽  
...  
Keyword(s):  
Contrast Media ◽  
Primary Pci ◽  
Contrast Induced Nephropathy ◽  
Cross Sectional ◽  
Number Of Patients ◽  
Contrast Volume ◽  
Percutaneous Coronary ◽  
Life Threatening ◽  
Short And Long Term

Background and Aims: Worldwide many patients are receiving intravascular contrast media (CM) during interventional procedures. Contrast media are used to enhance visualization and guide percutaneous coronary interventions (PCI).1 However, the use of CM also carries the risk of complications and it is important to be aware of these complications. Complications with CM range from mild symptoms to life-threatening conditions like anaphylaxis, hypotension and renal dysfunction and contrast-induced nephropathy (CIN) is one of them which can have both short and long term consequences.2 This study aimed to know the incidence of CIN in our center and possible predictors associated with it. Methods: This is the single hospital based cross sectional observational study. Patients undergoing primary PCI were enrolled in the study. All the patients underwent thorough history taking and physical examination. Baseline required laboratory investigations were sent. Electrocardiogram and echocardiography screening was done before taking patient to primary PCI as per the protocol of the hospital. Results: The number of patients enrolled in the study was 83 out of which 65(78.2%) were males and mean age was 59.7±13.2. Mean Arterial Pressure (MAP) among the patients was 103.8±21.3. Almost 2/3rd of the population received intravenous fluids. Minimum contrast volume used was 50ml and maximum was 270. When absolute rise in creatinine was considered 12 (14.5%) had CIN and when percent rise was also considered total 28 (33.7%) had CIN. While evaluating the predictors of CIN, higher mean age (p=0.01), hypotension with mean MAP <60 mmhg (p=0.04)) and higher contrast volume >100ml (p=0.04) was found to be significant. Conclusion: The incidence of CIN in patients undergoing PPCI was similar to the studies done in other parts of the world. Evaluating the predictors of CIN, higher mean age, hypotension and higher contrast volume was the significant predictor.

scholarly journals The role of process mining tools in STEMI networks: where should we build a new primary PCI centre?

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
J Borges-Rosa ◽  
M Oliveira-Santos ◽  
M Simoes ◽  
P Carvalho ◽  
G Ibanez-Sanchez ◽  
...  
Keyword(s):  
Time Delay ◽  
Hospital Mortality ◽  
Median Time ◽  
Symptom Onset ◽  
Process Mining ◽  
Reperfusion Therapy ◽  
Primary Pci ◽  
Global Comparison ◽  
Centre Region ◽  
Mining Tools

Abstract Background In ST-segment elevation myocardial infarction (STEMI), time delay between symptom onset and treatment is critical to improve outcome. The expected transport delay between patient location and percutaneous coronary intervention (PCI) centre is paramount for choosing the adequate reperfusion therapy. The “Centre” region of Portugal has heterogeneity in PCI assess due to geographical reasons. Purpose We aimed to explore time delays between regions using process mining (PM) tools. Methods We retrospectively assessed the Portuguese Registry of Acute Coronary Syndromes for patients with STEMI from October 2010 to September 2019, collecting information on geographical area of symptom onset, reperfusion option, and in-hospital mortality. We used a PM toolkit (PM4H – PMApp Version) to build two models (one national and one regional) that represent the flow of patients in a healthcare system, enhancing time differences between groups. One-way analysis of variance was employed for the global comparison of study variables between groups and post hoc analysis with Bonferroni correction was used for multiple comparisons. Results Overall, 8956 patients (75% male, 48% from 51 to 70 years) were included in the national model (Fig. 1A), in which primary PCI was the treatment of choice (73%), with the median time between admission and primary PCI &lt;120 minutes in every region; “Lisboa” and “Centro” had the longest delays, (orange arrows). Fibrinolysis was performed in 4.5%, with a median time delay &lt;1 hour in every region. In-hospital mortality was 5%, significantly higher for those without reperfusion therapy compared to PCI and fibrinolysis (10% vs. 4% vs. 4%, P&lt;0.001). In the regional model (Fig. 1B) corresponding to the “Centre” region of Portugal divided by districts (n=773, 74% male, 47% from 51 to 70 years), only 61% had primary PCI, with “Guarda” (05:04) and “Castelo Branco” (06:50) showing significant longer delays between diagnosis and reperfusion treatment (orange and red arrows, respectively) than “Coimbra” (01:19) (green arrow); only 15% of patients from “Castelo Branco” had primary PCI. Fibrinolysis was chosen in 10% of patients, mostly in “Castelo Branco” (53%), followed by “Guarda” (30%), with a median time delay of 39 and 48 minutes, respectively. Regarding mortality, PCI and fibrinolysis groups had similar death rates while those patients without reperfusion had higher mortality (5% vs. 3% vs. 13%, P=0.001). Conclusion Process mining tools help to understand referencing networks visually, easily highlighting inefficiencies and potential needs for improvement. The “Centre” region of Portugal has lower rates and longer delay to primary PCI partially due to the geographical reasons, with worse outcomes in remote regions. The implementation of a new PCI centre in one of these districts, is critical to offer timely first-line treatment to their population. FUNDunding Acknowledgement Type of funding sources: None. Figure 1

Mortality from all causes in patients with myocardial infarction with elevation of st segment depending on the type of reperfusion therapy (data of ryazan region, 2018-2020)

2020 ◽  
Vol 28 (4) ◽  
pp. 479-487
Author(s):  
Elena Parshikova ◽  
Evgenii Filippov
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Reperfusion Therapy ◽  
Primary Pci ◽  
Coronary Syndrome ◽  
End Point ◽  
St Segment ◽  
Percutaneous Coronary ◽  
The Given

Aim. To assess mortality from all causes in patients with past myocardial infarction with elevation of ST segment (STEMI) depending on the type of reperfusion therapy. Materials and Methods. Of 1456 patients hospitalized with acute coronary syndrome with elevation of ST segment, 848 cases were randomly selected for analysis. Acquisition of information of the end point (death from any causes) continued within 18 months. The present data were obtained by 01.10.2020, median of observation was 20.8 [17.4;23.6] months. Results. The highest 18-month mortality (42.3%) was seen in the group of patients who did not receive reperfusion therapy. With this, mortality rate for 30 days in the group of thrombolytic therapy (TLT) and in the group without reperfusion did not show any significant differences (20.3% vs 26.2%, р0.05). Hospital, 30-day, 12-month, 18-month mortality from all causes in the group of percutaneous coronary intervention (PCI) made 8.4, 10.6, 16.6 and 18.3%, respectively, and was significantly lower compared to the group who did not receive reperfusion (19.5, 26.2, 36.2 and 42.3%, respectively, р0,05). The most significant differences in the frequency of the end point were recorded on achievement of 18-month limit: in the group without reperfusion mortality was 42.3%, that was higher (р0.05) compared to the given parameter in the group with TLT (27.1%), PCI (18.3%) and TLT+PCI (13.1%). Conclusion. During 18 months of observation, the lowest mortality from all causes was observed in the group with use of pharmacoinvasive approach and primary PCI, the highest mortality was in the group of patients who did not receive reperfusion therapy.

Abstract 17491: Impact of Prehospital Administration of Antithrombotic Medications on Infarct-related Artery Patency in ST-elevation Myocardial Infarction: Results from the FAST-MI 2010 Registry

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Etienne Puymirat ◽  
Yves Cottin ◽  
Gilles Montalescot ◽  
Eric Bonnefoy-Cudraz ◽  
Laurent Bonello ◽  
...  
Keyword(s):  
Reperfusion Therapy ◽  
Primary Pci ◽  
Real World Data ◽  
Lower Tertile ◽  
Timi Flow ◽  
St Segment ◽  
Infarct Related Artery ◽  
St Elevation ◽  
French Registry ◽  
The Individual

Rationale: The role of prehospital (PH) antithrombotic medications in STEMI is debated; real-world data are scarce. We used the FAST-MI 2010 data to assess TIMI flow before PCI, in relation to PH administration of antithrombotic medications and timing of coronary angiography. Methods and Results: FAST-MI is a nationwide French registry including consecutive AMI patients in 213 centers in November 2010. Of 2364 STEMI patients, 2035 had TIMI flow assessed pre-intervention (1458 primary PCI, 289 lysis, 288 no reperfusion therapy); 41% had TIMI flow 2/3. PH use of antithrombotics was: ASA 52%, clopidogrel 37%, prasugrel 7%, GP IIb-IIIa 4%; unfractionated heparin 24%, other anticoagulants 22%. Mean age, risk factors, medical history, GRACE score, location of infarct did not differ between patients with TIMI 2/3 vs 0/1 flow. IRA patency was higher with time from onset to call less than 120min (45% vs 35%, P<0.001), and time from ECG to angio over 120 min (48% vs 33%,P<0.001). In the whole population, % TIMI flow 2/3 was higher with PH lytics (78% vs 42%, P<0.001) and differed according to PH antithrombotic use: no antiplatelet 42%, ASA alone 39%, clopidogrel 53.5%, prasugrel 58%, GPIIb-IIIa 40%; no anticoagulant 43%, UFH 46%, other anticoagulants 55%. Lysis (OR 5.67, 3.67-8.77), and combination of dual antiplatelets and anticoagulants (OR 1.59, 1.20-2.12) were independent correlates of higher patency. In patients with primary PCI, individual medications were not significantly correlated with IRA patency. Combined dual antiplatelet and anticoagulants, however, was a significant correlate of higher TIMI2/3 flow (adjusted OR 1.43, 1.05-1.96), as were shorter duration from onset to call (OR 1.53, 1.13-2.08) and longer time from ECG to angio (OR upper tertile vs lower tertile 1.65, 1.14-2.37). ST-segment resolution, reinfarction, stent thrombosis and TIMI major bleeding did not differ according to PH antithrombotics. Conclusion: In the whole population of STEMI patients (including lytic-treated patients), as in patients with primary PCI, PH administration of combined antiplatelet and anticoagulants is associated with increased IRA patency. In contrast, none of the individual antithrombotic medications significantly improved IRA patency.

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