scholarly journals Evaluation of a primary care paramedic STEMI bypass guideline

CJEM ◽  
2017 ◽  
Vol 20 (6) ◽  
pp. 850-856 ◽  
Author(s):  
Jonathan L. Kwong ◽  
Garry Ross ◽  
Linda Turner ◽  
Chris Olynyk ◽  
Sheldon Cheskes ◽  
...  
Keyword(s):  
Primary Care ◽  
Cardiac Arrest ◽  
Primary Outcome ◽  
Coronary Intervention ◽  
St Segment Elevation ◽  
Care Intervention ◽  
St Segment ◽  
Percutaneous Coronary ◽  
Significant Difference ◽  
The Difference

AbstractObjectiveLimited evidence supports primary care paramedic (PCP) direct transport of ST-segment elevation myocardial infarction (STEMI) patients for percutaneous coronary intervention (PCI). The goal of this study was to evaluate an urban-based PCP STEMI bypass guideline.MethodsWe reviewed consecutive Toronto Paramedic Services call reports between April 7, 2015, and May 31, 2016, regarding STEMI patients identified by PCPs. The primary outcome was patient assignment (stable versus unstable) according to guideline criteria. Secondary outcomes were the proportion of PCP-transported patients who had an indication for an advanced care intervention (ACI) or who received an ACI when PCPs rendezvoused with an advanced care paramedic (ACP). Lastly, we reviewed prehospital outcomes of cardiac arrest patients and calculated the difference in transport intervals between direct PCP bypass and a PCI-centre and predicted transport interval to the closest emergency department (ED).ResultsOf 361 patients, 232 were PCP transports and 129 were ACP-rendezvous transports. There was a significant difference in the distribution of stable and unstable patients between PCPs and ACPs (p<0.001). For PCP patients, 21/232 (9.1%) had indications for an ACI, whereas 34/129 (26.4%) ACP patients received an ACI. Eleven patients experienced cardiac arrest; 10 were successfully resuscitated (5 of these by PCPs). The median difference between direct PCP bypass and a PCI-centre versus transport to the closest ED was 5.53 minutes (IQR=6.71).ConclusionsWe found a significant difference in the distribution of stable and unstable patients and fewer patients with indications for an ACI in PCP patients. This PCP STEMI bypass guideline appears feasible.

scholarly journals Comparison of the Effects of Ticagrelor and Clopidogrel on Inflammatory Factors, Vascular Endothelium Functions and Short-Term Prognosis in Patients with Acute ST-Segment Elevation Myocardial Infarction Undergoing Emergency Percutaneous Coronary Intervention: a Pilot Study

2018 ◽  
Vol 48 (1) ◽  
pp. 385-396 ◽  
Author(s):  
Chang-Zheng Gao ◽  
Qian-Qian Ma ◽  
Jing Wu ◽  
Rui Liu ◽  
Fen Wang ◽  
...  
Keyword(s):  
Vascular Endothelium ◽  
Coronary Intervention ◽  
Control Group ◽  
Vascular Endothelial ◽  
St Segment Elevation ◽  
Acute Stemi ◽  
St Segment ◽  
Percutaneous Coronary ◽  
Significant Difference ◽  
Hs Crp

Background/Aims: Acute ST-segment elevation of myocardial infarction (STEMI) is the most severe type of acute coronary syndrome (ACS). Particular attention has been focused on studying the pathogenesis of STEMI, and how to prevent thrombosis, reduce inflammatory reaction, stabilize plaques and improve vascular endothelial functions to preserve the survived myocardium. This study aimed to compare the anti-inflammatory endothelium-protective effects, clinical prognosis, and relevant bleeding risks of ticagrelor versus clopidogrel in patients with STEMI who underwent urgent percutaneous coronary intervention (PCI) and provide certain experimental evidence and a theoretical basis for the selection of safe and effective drugs and their proper dosage, thereby further guiding clinical medication. Methods: We sequentially enrolled 193 patients (104 males and 89 females) admitted to hospital due to acute STEMI. These patients underwent urgent PCI between December 2013 and May 2015 and met the inclusion criteria. They were assigned (1: 1) into two groups according to different treatments, 97 patients in the ticagrelor group (treatment group), and 96 patients in the clopidogrel group (control group). Levels of hypersensitive C-reactive protein (hs-CRP), interleukin-6 (IL-6), and endothelial cell-specific molecule 1 (ESM-1) taken at admission and 24 h, 4 days, and 7 days after administration, as well as the correlation between the levels of IL-6, hs-CRP, and ESM-1, were determined in the two groups. At the same time, the effects of treatment with ticagrelor and clopidogrel on the efficacy endpoint events (ischemic and safety) were explored. Results: No statistically significant difference was found in the levels of hs-CRP, IL-6, or ESM-1 at admission between the two groups (P> 0.05); Their levels were significantly elevated 24 h after administration, with statistical differences between two groups (P< 0.05). Furthermore, a downward trend with statistically significant differences was found on Day 4 and Day 7 (P< 0.05); ESM-1 levels increased along with increases of hs-CRP and IL-6 levels, indicating ESM-1 was positively correlated with hs-CRP (r=0.523, P< 0.001) and IL-6 (r=0.431, P< 0.001); and the occurrence rates of ischemic endpoint events at 30 days were lower in the treatment group than in the control group. The occurrence of safety endpoint events was higher than in the control group; however, no statistically significant difference was found (P> 0.05). Conclusions: Compared with clopidogrel, ticagrelor appears to rapidly reduce the prevalence of inflammatory reactions and stabilize the functions of vascular endothelium to improve the stability of atherosclerotic plaque and decrease the occurrence rate of thrombosis as well as ischemic outcome events without any obvious increase in the risk of bleeding in patients with acute STEMI receiving urgent PCI. This renders it a potential drug for clinical practice. At the same time, measurement of ESM-1, a new biological marker for vascular endothelial function disorder, could possibly become a simple, effective, and practical new method for clinical evaluation of risk stratification of patients with acute STEMI at admission.

Abstract 18207: Role of Coronary Angiography with Successful Percutaneous Coronary Intervention in Patients with Out-of-Hospital Cardiac Arrest without ST-Segment Elevation Myocardial Infarction

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Yader Sandoval ◽  
David F Miranda ◽  
Steven R Goldsmith ◽  
Bradley A Bart ◽  
Stephen W Smith ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Cardiac Arrest ◽  
Coronary Angiography ◽  
Coronary Intervention ◽  
St Segment Elevation ◽  
St Segment ◽  
Percutaneous Coronary ◽  
The Impact ◽  
Referral Bias ◽  
Hospital Cardiac Arrest

Background: Emerging data have supported a strategy of earlier access to cardiac catheterization in patients with out-of-hospital cardiac arrest (OHCA). However, there are as yet no randomized controlled trials (RCT) addressing the issue, and the impact of percutaneous coronary intervention (PCI) on outcome is unclear in the absence of STEMI. We report here the characteristics and outcomes of patients with OHCA without STEMI undergoing coronary angiography (CA) with PCI vs. no PCI, in contrast to patients not undergoing CA. Methods: Single center, retrospective study of 195 patients with OHCA without STEMI between July 2007 and April 2014. Patients were categorized into CA vs. no CA (control), and among those undergoing CA we compared those treated with PCI vs. no PCI. Mortality was assessed along with key relevant clinical and angiographic variables in each group (Table). Results: 195 cases with OHCA without STEMI were reviewed, among which 102 (52%) did not undergo CA. 93 (48%) patients underwent CA, of which 21 (23%) underwent PCI, whereas 72 (77%) did not require PCI. Acute culprit lesion was identified in only 19 out of 93 (20.4%) Inpatient mortality was similar in those undergoing PCI vs. no PCI (19% vs. 14%, p=0.56). Patients that did not undergo CA had a significantly worse mortality, in comparison to patients undergoing CA (p<0.001). Conclusions: In this series of consecutive patients with OHCA without STEMI, culprit lesions were uncommon when CA was performed. Overall outcomes in patients receiving CA were better than in those not receiving CA, likely reflecting referral bias based on disease severity. However, successful PCI in patients with obstructive CAD and culprit lesions was not associated with improved inpatient survival. These findings emphasize the need for RCTs to guide the need for CA and/or PCI in these patients.

scholarly journals Does helicopter transport delay prehospital transfer for STEMI patients in rural areas? Findings from the CRAC France PCI registry

2019 ◽  
Vol 9 (8) ◽  
pp. 958-965 ◽  
Author(s):  
Radwan Hakim ◽  
Eric Revue ◽  
Christophe Saint Etienne ◽  
Pierre Marcollet ◽  
Stephan Chassaing ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Primary Percutaneous Coronary Intervention ◽  
Rural Areas ◽  
Coronary Intervention ◽  
Inhospital Mortality ◽  
St Segment Elevation ◽  
Transport Delay ◽  
St Segment ◽  
Percutaneous Coronary ◽  
Significant Difference

Aims: The aim of this study was to analyse delays in emergency medical system transfer of ST-segment elevation myocardial infarction (STEMI) patients to percutaneous coronary intervention (PCI) centres according to transport modality in a rural French region. Methods and results: Data from the prospective multicentre CRAC / France PCI registry were analysed for 1911 STEMI patients: 410 transferred by helicopter and 1501 by ground transport. The primary endpoint was the percentage of transfers with first medical contact to primary percutaneous coronary intervention within the 90 minutes recommended in guidelines. The secondary endpoint was time of first medical contact to primary percutaneous coronary intervention. With helicopter transport, time of first medical contact to primary percutaneous coronary intervention in under 90 minutes was less frequently achieved than with ground transport (9.8% vs. 37.2%; odds ratio 5.49; 95% confidence interval 3.90; 7.73; P<0.0001). Differences were greatest for transfers under 50 km (13.7% vs. 44.7%; P<0.0001) and for primary transfers (22.4% vs. 49.6%; P<0.0001). The median time from first medical contact to primary percutaneous coronary intervention and from symptom onset to primary percutaneous coronary intervention (total ischaemic time) were significantly higher in the helicopter transport group than in the ground transport group (respectively, 137 vs. 103 minutes; P<0.0001 and 261 vs. 195 minutes; P<0.0001). There was no significant difference in inhospital mortality between the helicopter and ground transport groups (6.9% vs. 6.6%; P=0.88). Conclusions: Helicopter transport of STEMI patients was five times less effective than ground transport in maintaining the 90-minute first medical contact to primary percutaneous coronary intervention time recommended in guidelines, particularly for transfer distances less than 50 km.

scholarly journals Impact of Coronary Lesion Stability on the Benefit of Emergent Percutaneous Coronary Intervention After Sudden Cardiac Arrest

2020 ◽  
Vol 13 (9) ◽  
Author(s):  
Louis Pechmajou ◽  
Eloi Marijon ◽  
Olivier Varenne ◽  
Florence Dumas ◽  
Frankie Beganton ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Odds Ratio ◽  
Sudden Cardiac Arrest ◽  
Coronary Intervention ◽  
Coronary Angiogram ◽  
St Segment Elevation ◽  
St Segment ◽  
Percutaneous Coronary ◽  
Coronary Lesions ◽  
Artery Disease

Background: Conflicting data exist regarding the benefit of urgent coronary angiogram and percutaneous coronary intervention (PCI) after sudden cardiac arrest, particularly in the absence of ST-segment elevation. We hypothesized that the type of lesions treated (stable versus unstable) influences the benefit derived from PCI. Methods: Data were taken between May 2011 and 2014 from a prospective registry enrolling all sudden cardiac arrest in Paris and suburbs (6.7 million inhabitants). Patients undergoing emergent coronary angiogram were included. Decision to perform PCI was left to the discretion of local teams. We assessed the impact of emergent PCI on survival at discharge according to whether the treated lesion was angiographically unstable or stable, and we investigated the predictive factors for unstable coronary lesions. Results: Among 9265 sudden cardiac arrests occurring during the study period, 1078 underwent emergent coronary angiogram (median age: 59.6 years, 78.3% males): 463 (42.9%) had an unstable lesion, 253 (23.5%) only stable lesions, and 362 (33.6%) no significant lesions. Emergent PCI was performed in 478 patients (91.4% of unstable and 21.7% of stable lesions). At discharge, PCI of unstable lesions was associated with twice-higher survival rate compared with untreated unstable lesions (47.9% versus 25.6%, P =0.013), while stable lesions PCI did not improve survival (25.5% versus 26.3%, P =1.00). After adjustment, PCI of unstable coronary lesions was independently associated with improved survival (odds ratio, 2.09 [95% CI, 1.42–3.09], P <0.001), contrary to PCI of stable lesions (odds ratio, 0.92 [95% CI. 0.44–1.87], P =0.824). Angina, initial shockable rhythm, ST-segment elevation, and absence of known coronary artery disease were independent predictors of unstable lesions. Conclusions: Emergent PCI of unstable lesions is associated with improved survival after sudden cardiac arrest, contrary to PCI of stable lesions. Accordingly, early PCI should only be performed in patients with unstable lesions. Four factors (chest pain, ST-elevation, absence of coronary artery disease history, and shockable initial rhythm) could help identify patients with unstable lesions who would, therefore, benefit from emergent coronary angiogram.

scholarly journals Adjunctive Catheter-Directed Thrombolysis during Primary PCI for ST-Segment Elevation Myocardial Infarction with High Thrombus Burden

2022 ◽  
Vol 11 (1) ◽  
pp. 262
Author(s):  
Satsuki Noma ◽  
Hideki Miyachi ◽  
Isamu Fukuizumi ◽  
Junya Matsuda ◽  
Hideto Sangen ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Intervention ◽  
Bleeding Complications ◽  
Aspiration Thrombectomy ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
Catheter Directed Thrombolysis ◽  
St Segment ◽  
Percutaneous Coronary ◽  
Significant Difference

Background: High coronary thrombus burden has been associated with unfavorable outcomes in patients with ST-segment elevation myocardial infarction (STEMI), the optimal management of which has not yet been established. Methods: We assessed the adjunctive catheter-directed thrombolysis (CDT) during primary percutaneous coronary intervention (PCI) in patients with STEMI and high thrombus burden. CDT was defined as intracoronary infusion of tissue plasminogen activator (t-PA; monteplase). Results: Among the 1849 consecutive patients with STEMI, 263 had high thrombus burden. Moreover, 41 patients received t-PA (CDT group), whereas 222 did not receive it (non-CDT group). No significant differences in bleeding complications and in-hospital and long-term mortalities were observed (9.8% vs. 7.2%, p = 0.53; 7.3% vs. 2.3%, p = 0.11; and 12.6% vs. 17.5%, p = 0.84, CDT vs. non-CDT). In patients who underwent antecedent aspiration thrombectomy during PCI (75.6% CDT group and 87.4% non-CDT group), thrombolysis in myocardial infarction grade 2 or 3 flow rate after thrombectomy was significantly lower in the CDT group than in the non-CDT group (32.2% vs. 61.0%, p < 0.01). However, the final rates improved without significant difference (90.3% vs. 97.4%, p = 0.14). Conclusions: Adjunctive CDT appears to be tolerated and feasible for high thrombus burden. Particularly, it may be an option in cases with failed aspiration thrombectomy.

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