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.

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.

463Temporal trends in latecomer ST-segment elevation myocardial infarction patients: Insights from the AMIS Plus Registry 1997–2017

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Roberto ◽  
D Radovanovic ◽  
L Biasco ◽  
A Quagliana ◽  
P Erne ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Hospital Mortality ◽  
Temporal Trends ◽  
Late Presentation ◽  
Evidence Based ◽  
Absolute Rate ◽  
Pharmacological Treatments ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment

Abstract Introduction A relevant proportion of patients experiencing ST-segment elevation myocardial infarction (STEMI) has a late presentation after symptoms onset. Temporal trends deriving from a large real-word scenario for this subgroup of patients are lacking. Purpose The aim of the present study was to provide a comprehensive analysis of temporal trends in latecomer STEMI patients, with particular regard to implementation of evidence-based treatments in this population and major in-hospital outcomes. Methods All STEMI patients included in the AMIS Plus Registry from January 1997 to December 2017 were included and patient-related delay was assessed: 27 231 patients were available for the final analysis. STEMI patients were classified as early or latecomers according to patient-related delay (≤ or >12 hours, respectively). Results 22 928 patients were earlycomers (84%) and 4303 patients were classified as latecomers (16%). Across the study period we observed a significant decrease in prevalence of late presentation from 22% to 12.3% (p<0.001, Figure 1). In latecomer STEMI patients there was a gradual uptake of evidence-based pharmacological treatments with an increase in discharge prescription of P2Y12 inhibitors from 6% to 90.7% (p<0.001). Similarly, a marked increase in percutaneous coronary intervention (PCI) rate was observed (12.1–86.6%; p<0.001). Across this 20-year period, in-hospital mortality was reduced to a third (to an absolute rate of 4.5%, p<0.001) and a significant reduction in prevalence of both cardiogenic shock (14.6–4.3%) and re-infarction (5.4–0.2%) during the index hospitalisation was observed (p<0.001 for both variables). Length of hospitalisation in acute care facilities significantly decreased from 10 (6,14) days to 4 (1,7) days (p<0.001). At multivariate analysis, PCI had a strong independent protective effect toward in-hospital mortality (odds ratio 0.3, 95% confidence interval 0.187 to 0.480). Figure 1 Conclusion The present study provides a comprehensive picture of temporal trends in late presentation in STEMI over the last 20 years in Switzerland. During the study period in latecomer STEMI population there was a gradual uptake of evidence-based pharmacological treatments and a marked increase in PCI rate. In-hospital mortality was reduced to a third (to an absolute rate of 4.5%) and this reduction seems to be mainly associated with the increasing implementation of PCI.

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

scholarly journals Trends in reperfusion therapy for acute ST-segment elevation myocardial infarction in an academic PCI centre in the metropolitan area of a developing country

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S Dharma ◽  
I Dakota ◽  
H Andriantoro ◽  
I Firdaus ◽  
I.G Limadhy ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Metropolitan Area ◽  
Coronary Intervention ◽  
Reperfusion Therapy ◽  
Primary Pci ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Percutaneous Coronary

Abstract Background Long-term reports on reperfusion therapy for acute ST-segment elevation myocardial infarction (STEMI) in developing countries are scarce. Purpose We reported changes in acute reperfusion therapy for STEMI that have been observed over time in an academic tertiary care percutaneous coronary intervention (PCI) centre that hosting a STEMI network in the large metropolitan area of Jakarta, Indonesia since 2010 and covering around 11 million inhabitants. Methods A retrospective analysis was performed in 6336 patients with STEMI who admitted to the emergency department of a PCI centre in 2008 (before STEMI network introduction), and during 2011 to 2018. Results Among STEMI patients admitted during 2011–2018 (mean age: 56±10 years, 86% male), 57.6% had anterior wall myocardial infarction, and 71.3% presented with Killip classification I. Compared with the period 2011–2014 (N=2766), patients who were admitted in the period 2015–2018 (N=3250) were receiving more primary percutaneous coronary intervention (PCI) (61.6% vs. 44.2%, P&lt;0.001) with shorter door-to-device time (median 72 min versus 97 min, P&lt;0.001), and less in-hospital fibrinolytic therapy (2.7% vs. 4.8%, P&lt;0.001). The percentage of STEMI patients who did not receive reperfusion treatment decreased from 51% to 35.5% (P&lt;0.001). In-hospital mortality declined from 10% in 2008 (before the STEMI network was initiated) and 8% in 2011 to 6.4% in 2018 (P for trends = 0.05). Multivariable analysis showed that primary PCI was significantly associated with better in-hospital survival (adjusted odds ratio, 0.52; 95% confidence interval, 0.42 to 0.65, P&lt;0.001). Conclusion The data indicate that the introduction of a STEMI network resulted in more patients receiving timely primary PCI and lower early mortality rates in recent years. Funding Acknowledgement Type of funding source: None

scholarly journals Factors associated with pre-hospital delay before reperfusion therapy in patients with ST-segment elevation myocardial infarction

2018 ◽  
Vol 6 (2) ◽  
Author(s):  
Ram Chandra Kafle ◽  
Navaraj Paudel ◽  
Girija Shankar Jha ◽  
Dibya Sharma ◽  
Vijay Madhav Alurkar
Keyword(s):  
Myocardial Infarction ◽  
Negative Impact ◽  
Public Awareness ◽  
Medical Officer ◽  
Reperfusion Therapy ◽  
Delayed Presentation ◽  
Early Reperfusion ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment

Introduction: Cardiovascular disease remains the main cause of death in the world, and myocardial infarction represents the main contributor to this mortality. Timely restoration of myocardial blood flow with reperfusion therapy is crucial. Pre-hospital delay is a major obstacle for early reperfusion therapy and has negative impact on mortality and left ventricle function. Methods: A prospective study was carried in cardiology unit of a medical college from August 2013 to December 2017. Cases of acute ST segment elevation myocardial infarction that have undergone thrombolysis were recruited. Results: Out of 450 patients with ST Elevation Myocardial Infection (STEMI), delayed presentation was seen in 288 (64%) for >6 hrs and 108 (24%) patients for >12 hrs. The duration from onset of symptoms to the presentation in the emergency room (pre-hospital delay) was 12.66 hrs (SD=14.19, range = 30 min to 72 hrs). The door to needle time was 54 min (SD=24) The major factors for pre-hospital delay were misinterpretation of symptoms (59%) and transportation problems (31%). Conclusion: Misinterpretation of symptoms remain the most common cause of delayed presentation. Health education for public awareness can reduce the delay. Extension of thrombolytic therapy to district hospital and primary health center level after basic training for medical officer with checklist and collaboration in form of telemedicine with referral cardiac center may have major impact on morbidity and mortality reduction in acute STEMI patients with early reperfusion therapy.

scholarly journals Comparison of in-hospital outcome of patients of myocardial infarction with and without streptokinase reperfusion therapy.

2020 ◽  
Vol 27 (09) ◽  
pp. 1971-1975
Author(s):  
Fida Muhammad ◽  
Amir Nazeer ◽  
Sheraz Saleem ◽  
Nighat Fatima ◽  
Shahzad Aslam
Keyword(s):  
Myocardial Infarction ◽  
Hospital Mortality ◽  
Reperfusion Therapy ◽  
Test Results ◽  
Chi Square ◽  
Hospital Outcome ◽  
Cardiology Department ◽  
Co Morbidity ◽  
Chi Square Test ◽  
History Of

Objectives: To compare the in-hospital outcome and complications with and without reperfusion therapy with streptokinase among patients with myocardial infarction was the objective of this study. Study Design: Prospective study. Setting: Cardiology Department, Divisional Headquarter Teaching, Hospital, Sargodha. Period: March 2018 to December 2018. Material & Methods: Three hundred (300) patients with acute STEMI of either gender and above 20 years of age, were divided into two groups (180 patients received SK and 120 patients didn’t receive SK. Demographic features, history and physical examination were noted. In hospital mortality and complications were recorded and compared between groups by chi-square test. Results: There were 76.0% male and 24.0% females with mean age of 55.61±11.35 years. Family history of IHD was present in 28.34% patients and 35.0% patients were smoker. Commonest co-morbidity was hypertension (73.34%), followed by diabetes mellitus (36.67%). In-hospital mortality was 6.6% in SK group and 31.6% in non-SK group (p= <0.001). Overall, in-hospital mortality was 16.67%. LVF was 8.33% and 23.33% (p= <0.001), Mitral regurgitation 1.11% and 2.5% (p=0.848), VT/VF 3.33% and 5.83% (p=0.297), Complete heart block 2.22% and 5.83% (p=0.103), Atrial fibrillation 0.55% and 1.67% (p=0.343), Post MI angina 3.33% and 13.33% (p=0.001), Re-infarction 1.11% and 3.33% (p=0.178), CVA 0.0.55% and 0.0% (p=0.812), Ventral septal defect 0.0% and 3.33% (p=0.029) and Hypotension was 25% and 8.33% (p=0.001)in SK and non SK groups, respectively. Conclusions: Reperfusion therapy with streptokinase among patients with myocardial infarction was found effective in terms of significant low in-hospital mortality rate and low complication rate.

scholarly journals CHA2DS2-VASc Score as an Independent Predictor of Suboptimal Reperfusion and Short-Term Mortality after Primary PCI in Patients with Acute ST Segment Elevation Myocardial Infarction

Medicina ◽  
2019 ◽  
Vol 55 (2) ◽  
pp. 35 ◽  
Author(s):  
Ammar Ashoori ◽  
Hamidreza Pourhosseini ◽  
Saeed Ghodsi ◽  
Mojtaba Salarifar ◽  
Ebrahim Nematipour ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Hospital Mortality ◽  
Area Under The Curve ◽  
Primary Angioplasty ◽  
Primary Pci ◽  
Short Term ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
No Reflow ◽  
Risk Stratification Tool

Background and objectives: We aimed to demonstrate the clinical utility of CHA2DS2-VASc score in risk assessment of patients with STEMI regarding adverse clinical outcomes particularly no-reflow phenomenon. Materials and Methods: We designed a retrospective cohort study using the data of Tehran Heart Center registry for acute coronary syndrome. The study included 1331 consecutive patients with STEMI who underwent primary angioplasty. Patients were divided into two groups according to low and high CHA2DS2-VASc score. Angiographic results of reperfusion were inspected to evaluate the association of high CHA2DS2-VASc score and the likelihood of suboptimal TIMI flow. The secondary endpoint of the study was short-term in-hospital mortality of all cause. Results: The present study confirmed that CHA2DS2-VASc model enables us to determine the risk of no-reflow and all-cause in-hospital mortality independently. Odds ratios were 1.59 (1.30–2.25) and 1.60 (1.17–2.19), respectively. Moreover, BMI, high thrombus grade, and cardiogenic shock were predictors of failed reperfusion (odds were 1.07 (1.01–1.35), 1.59 (1.28–1.76), and 8.65 (3.76–24.46), respectively). We showed that using a cut off value of ≥ two in CHA2DS2-VASc model provides a sensitivity of 69.7% and specificity of 64.4% for discrimination of increased mortality hazards. Area under the curve: 0.72 with 95% CI (0.62–0.81). Conclusions: Calculation of CHA2DS2-VASc score applied as a simple risk stratification tool before primary PCI affords great predictive power. Furthermore, incremental values are obtained by using both CHA2DS2-VASc and no-reflow regarding mortality risk assessment.

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

2021 ◽  
Vol 2 (4) ◽  
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. Funding Acknowledgement Type of funding sources: None. Figure 1

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