1. Time delays in each step from symptom onset to treatment in acute myocardial infarction: Results from a nation-wide TURKMI registry
- Author
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Oğuz Yavuzgil, Nadir Emlek, Emine Gazi, Sinan Inci, Öner Özdoğan, Nihan Turhan Cağlar, Eftal Murat Bakirci, Bilge Duran Karaduman, Yakup Alsancak, Ramazan Düz, Mehmet Ali Astarcıoğlu, Mustafa Kılıçkap, Meral Kayıkçıoğlu, Mustafa Kürşat Tigen, Mustafa Kemal Erol, Çağrı Yayla, Mehmet Inanir, Fatih Pasa Tatar, Arda Güler, Ömer Faruk Çırakoğlu, Önder Öztürk, İsmail Balaban, Burcu Tuncay, Ekrem Aksu, Tıp Fakültesi, RTEÜ, Tıp Fakültesi, Dahili Tıp Bilimleri Bölümü, Emlek, Nadir, BAİBÜ, Tıp Fakültesi, Dahili Tıp Bilimleri Bölümü, and İnanır, Mehmet
- Subjects
Emergency Medical Services ,medicine.medical_specialty ,Time delays ,Time Factors ,Treatment Delay ,medicine.medical_treatment ,Myocardial Infarction ,Segment Elevation ,Total ischemic time ,Ambulance ,Percutaneous Coronary Intervention ,medicine ,Diseases of the circulatory (Cardiovascular) system ,Humans ,In patient ,Registries ,cardiovascular diseases ,Myocardial infarction ,Symptom onset ,Original Investigation ,Door to balloon time ,business.industry ,Percutaneous coronary intervention ,Treatment delay ,medicine.disease ,Door to Balloon Time ,Treatment center ,RC666-701 ,Hospital admission ,Conventional PCI ,Emergency medicine ,ST Elevation Myocardial Infarction ,Cardiology and Cardiovascular Medicine ,business ,Total Ischemic Time - Abstract
Objective: In this study, we aimed to analyze the TURKMI registry to identify the factors associated with delays from symptom onset to treatment that would be the focus of improvement efforts in patients with acute myocardial infarction (AMI) in Turkey. Methods: The TURKMI study is a nation-wide registry that was conducted in 50 centers capable of 24/7 primary percutaneous coronary intervention (PCI). All consecutive patients (n=1930) with AMI admitted to coronary care units within 48 hours of symptom onset were prospectively enrolled during a predefined 2-week period between November 1, 2018, and November 16, 2018. All the patients were examined in detail with regard to the time elapsed at each step from symptom onset to initiation of treatment, including door-to-balloon time (D2B) and total ischemic time (TIT). Results: After excluding patients who suffered an AMI within the hospital (2.6%), the analysis was conducted for 1879 patients. Most of the patients (49.5%) arrived by self-transport, 11.8% by emergency medical service (EMS) ambulance, and 38.6% were transferred from another EMS without PCI capability. The median time delay from symptom-onset to EMS call was 52.5 (15-180) min and from EMS call to EMS arrival 15 (10-20) min. In ST-segment elevation myocardial infarction (STEMI), the median D2B time was 36.5 (25-63) min, and median TIT was 195 (115-330) min. TIT was significantly prolonged from 151 (90-285) min to 250 (165-372) min in patients transferred from non-PCI centers. The major significant factors associated with time delay were patient-related delay and the mode of hospital arrival, both in STEMI and non-STEMI. Conclusion: The baseline evaluation of the TURKMI study revealed that an important proportion of patients presenting with AMI within 48 hours of symptom onset reach the PCI treatment center later than the time proposed in the guidelines, and the use of EMS for admission to hospital is extremely low in Turkey. Patient-related factors and the mode of hospital admission were the major factors associated with the time delay to treatment., Turkish Society of Cardiology from AstraZeneca, Statistical analyses were conducted by Omega CRO, Ankara, Turkey. The electronic case report form and the data capture program (OpenClinica LLC and collaborators, Waltham, MA, USA) hosted were by Omega CRO, Ankara, Turkey. TURKMI registries are investigator-initiated trials and sponsored by the Turkish Society of Cardiology, which received major, unrestricted funding from AstraZeneca for this project. The funder had no role in study design, data collection, data analysis, data interpretation, or writing of the report.
- Published
- 2021