scholarly journals Mobile application to optimize care for STEMI patients in a large healthcare system, STEMIcathAID. Rationale and design

2021 ◽  
Author(s):  
Parasuram Krishnamoorthy ◽  
Andriy Vengrenyuk ◽  
Brian Wasielewski ◽  
Nitin Barman ◽  
Jeffrey Bander ◽  
...  
Keyword(s):  
Healthcare System ◽  
Mobile Application ◽  
Performance Metrics ◽  
Clinical Status ◽  
Coronary Intervention ◽  
Mobile App ◽  
Gps Tracking ◽  
St Segment Elevation ◽  
Catheterization Laboratory ◽  
Cardiac Catheterization Laboratory

Abstract Technological advancements have transformed healthcare. System delays in transferring patients with ST- segment elevation myocardial infarction (STEMI) to a primary percutaneous coronary intervention (PCI) center are associated with worse clinical outcomes. Our aim was to design and develop a secure mobile application, STEMIcathAID, streamlining communication and coordination between the STEMI care teams to reduce ischemia time and improve patient outcomes. The app was designed for transfer of patients with STEMI to a cardiac catheterization laboratory (CCL) from an emergency department (ED) of either a PCI capable or a non-PCI capable hospital. When a suspected STEMI arrives to a non-PCI hospital ED, the ED physician uploads the EKG and relevant patient information. An instant notification is simultaneously sent to the on-call CCL attending and transfer center. The attending reviews the information, makes a video call and decides to either accept or reject the transfer. If accepted, on-call CCL team members receive an immediate push notification and begin communicating with the ED team via a HIPPA compliant chat. The app provides live GPS tracking of the ambulance and frequent clinical status updates of the patient. In addition, it allows for screening of STEMI patients in cardiogenic shock. Prior to discharge important data elements have to be entered to close the case. In conclusion, we developed a novel mobile app to optimize care for STEMI patients and facilitate electronic extraction of relevant performance metrics to improve allocation of resources and reduction of costs.

scholarly journals Age independently predicts hemodynamic, but not arrhythmic STEMI-related complications. Data from a cohort study on 848 STEMI patients

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
RC Serban ◽  
L Hadadi ◽  
I Sus ◽  
EK Lakatos ◽  
Z Demjen ◽  
...  
Keyword(s):  
Heart Failure ◽  
Coronary Intervention ◽  
Hospital Death ◽  
High Risk Population ◽  
Time Interval ◽  
Killip Class ◽  
St Segment Elevation ◽  
Catheterization Laboratory ◽  
Cardiac Stimulation ◽  
Cardiac Catheterization Laboratory

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Romanian Ministry of Education and Research, CNCS-UEFISCDI BACKGROUND Age is one of the most relevant prognostic factors in patients presenting with ST-segment elevation myocardial infarction (STEMI). However, it remains unknown whether this impaired prognosis is due to the occurrence of hemodynamic and/or arrhythmic STEMI-related complications. Understanding the mechanisms involved in STEMI-related complications with advancing age could significantly improve outcomes in this high-risk population. PURPOSE We aimed to investigate the contribution of advanced age to the occurrence of hemodynamic and arrhythmic complications in STEMI patients. METHODS A total of 848 consecutive patients treated by primary percutaneous coronary intervention for STEMI were evaluated. Heart failure, cardiogenic shock, asystole, inotropic and diuretic use, and kidney dysfunction were used as in-hospital markers of hemodynamic complications. Ventricular fibrillation, conduction disorders, cardiac stimulation, and antiarrhythmic drugs use were used as markers of arrhythmic complications. The relationship between age and the occurrence of hemodynamic and arrhythmic complications was evaluated. The contribution of age to in-hospital death was also assessed. RESULTS In-hospital death occurred in 50 (5.8%) patients; patients who deceased were significantly older than their non-deceased counterparts (70.9 ± 10.9 vs. 61.2 ± 11.8 years; p< 0.0001). There was no association between age and the occurrence of any of the evaluated arrhythmic complications (all p >0.05). However, patients who presented hemodynamic complications were significantly older than those who did not (all p< 0.05). Age >60 years was a significant predictor of hemodynamic complications (p< 0.0001) with 61.7% sensitivity and 60.4% specificity. The association between age and hemodynamic complications remained significant after correction for additional risk factors (i.e., hypertension, diabetes mellitus, pre-existing heart failure, Killip class on admission, symptom onset-to-cardiac catheterization laboratory time interval). CONCLUSIONS In the present study, age was identified as an independent predictor of STEMI-related hemodynamic, but not arrhythmic complications. These data indicate that whereas age does not seem to affect the occurrence of STEMI-related rhythm disorders, patients above the age of 60 should particularly benefit from closer follow-up and more intensive strategies to prevent life-threating hemodynamic complications.

Abstract 19059: Thermodilution-derived Coronary Blood Flow Pattern Immediately After Coronary Intervention as a Predictor of Long-term Clinical Outcomes in Patients With ST-segment Elevation Myocardial Infarction

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Masashi Fukunaga ◽  
Kenichi Fujii ◽  
Machiko Nishimura ◽  
Tetsuo Horimatsu ◽  
Ten Saita ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Intervention ◽  
St Segment Elevation ◽  
Catheterization Laboratory ◽  
Cardiac Catheterization Laboratory ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Temperature Time ◽  
Thermodilution Curve

Background: We reported that coronary blood flow (CBF) can be evaluated by analyzing thermodilution curve that is measured with a single pressure sensor/thermistor-tipped guidewire in the cardiac catheterization laboratory during percutaneous coronary intervention (PCI). Bimodal shape of thermodilution curve was associated with microvascular damage and predictors of left ventricular functional recovery after ST-segment elevation myocardial infarction (STEMI). However it is unknown whether the bimodal shape of thermodilution curve predicts mortality and re-hospitalization for heart failure in long term period for patients experiencing STEMI. Methods: Between September 2009 and August 2012, 97 consecutive patients with a first STEMI were prospectively enrolled in this study. Using a pressure sensor/thermistor-tipped guidewire, CBF pattern was assessed from the thermodilution-curves after successful PCI at maximum hyperemia. CBF pattern was classified into 3 groups according to the shape of thermodilution curve: a narrow unimodal (a rapid fall and rise of temperature-time curves) (n=47), a wide unimodal (a gradual fall and rise of temperature-time curves) (n=33), or bimodal (two populations with valley deeper than 20% of peak temperature drop) (n=17). Major adverse cardiac events (MACE) were defined as cardiac death and/or heart failure re-hospitalization within this study period. Results: Median follow-up period was 2.4 years. Although patients in the narrow-unimodal group and the wide unimodal group had a significantly lower incidence of MACE, patients in bimodal group had a higher risk of MACE during this study period (71, 15, 21%, p<0.001). Multivariate analysis revealed that bimodal shape of the thermodilution-curve was the only independent predictor of MACE after STEMI (hazard ratio, 8.38; 95% confidence interval, 2.13-33.00; P=0.0023). Conclusions: A bimodal shape of the thermodilution curve is associated with the poor long-term clinical outcomes. This easily assessable coronary flow pattern is useful in clinical risk stratification for STEMI patients in the cardiac catheterization laboratory immediately after PCI.

Myocardial Infarction Management and Decreased Utilization of Percutaneous Coronary Intervention During the Era of COVID-19 Pandemic

2021 ◽  
Author(s):  
Jagmit Singh
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
The United States ◽  
St Segment Elevation ◽  
Catheterization Laboratory ◽  
Cardiac Catheterization Laboratory ◽  
St Segment ◽  
Percutaneous Coronary ◽  
Primary Focus

We read with great interest the article, 'Reduction in ST-Segment Elevation Cardiac Catheterization Laboratory Activations in the United States during COVID-19 Pandemic' [1]. This study's primary focus was to determine the efficacy of hospital resources' response and capability amid the coronavirus disease (COVID-19) outbreak and suspected consequences for patients with myocardial infarction that are eligible for percutaneous coronary intervention (PCI)

scholarly journals Outcomes of primary percutaneous coronary intervention (PCI) in NICVD, Dhaka,Bangladesh- our initial experiences

2015 ◽  
Vol 9 (2) ◽  
pp. 83-87 ◽  
Author(s):  
Mir Jamaluddin ◽  
Ibrahim Khalil ◽  
Kajal Kumar Karmakar ◽  
Humayun Kabir ◽  
Rakibul Islam Litu ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Primary Percutaneous Coronary Intervention ◽  
Positive Family History ◽  
Coronary Intervention ◽  
Bare Metal Stent ◽  
Drug Eluting Stent ◽  
Primary Pci ◽  
Catheterization Laboratory ◽  
Cardiac Catheterization Laboratory ◽  
Percutaneous Coronary

The aim of the study is to determine the out comes of primary percutaneous coronary intervention (PCI) in patients with acute myocardial infarction in NICVD the only government cardiac hospital of Bangladesh where resources are very limited. Total 73 (male 70, female 3) patients were enrolled in this study who were brought in to our hospital with STEMI between August 2010 to October 2013. Average age was 55.6 ±11.78. Primary PCI was performed after transferring patient from Emergency Department to cardiac catheterization laboratory. Cardiovascular risk factors among the studied population were Diabetes mellitus, Hypertension, Smoking, Dyslipidemia and Positive family history for IHD. Primary PCI either with Bare Metal Stent (BMS) or Drug Eluting Stent (DES) were performed in total 42 LAD lesions, 28 RCA lesions and 3 LCX lesions. BMS used were 87.7%, DES used were 12.3%. The procedural success was 95.8%.Four patients (5.4%) died during hospital stay. Out of four patients who died, one had cardiogenic shock. No mortality was observed in the 30 days follow up from discharge, while other complications like unstable angina and congestive heart failure were 5.7% and 4.3% respectively. Our findings suggest favorable outcomes, matching the international data which was achieved in our patients with primary PCI in the management of STEMI despite all the limitations. Primary PCI as a preferred method of reperfusion strategy needs to be practiced more often in our part of world.University Heart Journal Vol. 9, No. 2, July 2013; 83-87

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