Predictors of primary percutaneous coronary intervention delay in cases of myocardial infarction diagnosed in hospitals without hemodynamic support systems
Por:
Ruiz, AC, Utset, JM, Ariza-Sole, A, Gomez-Hospital, JA, Carrillo, X, Tizon, H, Garcia-Picart, J, Regueiro, A, Munoz-Camacho, JF, Lidon, RM, Fabrega, XJ and Mauri, F
Publicada:
1 jun 2021
Resumen:
Objetive. The need for primary percutaneous coronary intervention in hospitals without hemodynamic support capability is associated with delays between first medical contact (FMC) and reperfusion. It is important to identify factors involved in delays, particularly if they are relevant to the organization of emergency services.
Methods. Analysis of a registry of patients treated in hospitals without advanced hemodynamic support systems in a catchment area with an established care network for acute ST-segment elevation myocardial infarction (STEMI). The registry included care times.
Results. The network served 2542 patients with a mean (SD) age of 63(13) years. FMC-to-reperfusion time was within 120 minutes in 42% of the cases. Nine of the hospitals had a chest-pain unit in the emergency department, and this factor was an independent predictor of FMC-to-reperfusion times of 120 minutes or less (odds ratio, 0.64; 95% Cl, 0.54-0.77; P <.0001); the time was shortened by 11 minutes in such hospitals. FMC-to-reperfusion was delayed beyond 120 minutes in relation to the following factors: shock and need for intubation at start of care, age, gender, FMC at night, left bundle branch block, and Killip class. One-month and 1 -year mortality rates increased in hospitals without hemodynamic support systems in proportion to reperfusion delay, by 1.7% and 3.5% if the delay was 106 minutes or less and by 7.3% and 12.4% if the delay was 176 minutes or longer (P <.0001).
Conclusions. FMC-to-reperfusion time in STEMI exceeds recommendations in 58% of the hospitals without hemodynamic support systems and delay is inversely proportional to the availability of an emergency department chest pain unit. One-month and 1 -year mortality is proportional to the degree of delay.
Filiaciones:
Ruiz, AC:
Unidad Hospitalizac, Hosp Moises Broggi, Serv Cardiol, Barcelona, Spain
Utset, JM:
Hosp Moises Broggi, Serv Med Intens, Barcelona, Spain
Ariza-Sole, A:
Hosp Bellvitge Princeps Espanya, Serv Cardiol, Unidad Cuidados Intensivos Cardiol, Barcelona, Spain
Gomez-Hospital, JA:
Hosp Bellvitge Princeps Espanya, Serv Cardiol, Unidad Cardiol Intervencionista, Barcelona, Spain
:
Hosp GermansTrias & Pujol, Serv Cardiol, Unidad Cardiol Intervencionista, Barcelona, Spain
Tizon, H:
Hosp Mar, Serv Cardiol, Unidad Cardiol Intervencionista, Barcelona, Spain
Garcia-Picart, J:
Hosp Santa Creu & Sant Pau, Unidad Cardiol Intervencionista, Serv Cardiol, Barcelona, Spain
Regueiro, A:
Hosp Clin Barcelona, Serv Cardiol, Unidad Cardiol Intervencionista, Barcelona, Spain
Munoz-Camacho, JF:
Mutua Terrassa, Unidad Cardiol Intervencionista, Serv Cardiol, Barcelona, Spain
Lidon, RM:
Hosp Hebron, Serv Cardiol, Unidad Cuidados Agudos Cardiol, Barcelona, Spain
Fabrega, XJ:
Sistema Emergencies Med, Barcelona, Spain
Mauri, F:
Generalitat Catalunya, Dept Salut, Directora Pla Director Malaties Cardiovasc, Barcelona, Spain
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