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Predictors of Late Reperfusion in STEMI Patients Undergoing Primary Angioplasty. Impact of the Place of First Medical Contact.
- Source :
-
Revista espanola de cardiologia (English ed.) [Rev Esp Cardiol (Engl Ed)] 2017 Mar; Vol. 70 (3), pp. 162-169. Date of Electronic Publication: 2016 Dec 27. - Publication Year :
- 2017
-
Abstract
- Introduction and Objectives: The benefit of primary angioplasty may be reduced if there are delays to reperfusion. Identification of the variables associated with these delays could improve health care.<br />Methods: Analysis of the Codi Infart registry of Catalonia and of the time to angioplasty depending on the place of first medical contact.<br />Results: In 3832 patients analyzed, first medical contact took place in primary care centers in 18% and in hospitals without a catheterization laboratory in 37%. Delays were longer in these 2 groups than in patients attended by the outpatient emergency medical system or by hospitals with a catheterization laboratory (P < .0001, results in median): first medical contact to reperfusion indication time was 42minutes in both (overall 35minutes); first medical contact to artery opening time was 131 and 143minutes, respectively (overall 121minutes); total ischemia time was 230 and 260minutes (overall 215minutes). First medical contact to artery opening time > 120minutes was strongly associated with first medical contact in a center without a catheterization laboratory (OR, 4.96; 95% confidence interval, 4.14-5.93), and other factors such as age, previous coronary surgery, first medical contact during evening hours, nondiagnostic electrocardiogram, and Killip class ≥ III. Mortality at 30 days and 1 year was 5.6% and 8.7% and was independently associated with age, longer delay to angioplasty, Killip class ≥ II, and first medical contact in a center with a catheterization laboratory.<br />Conclusions: In more than 50% of patients requiring primary angioplasty, the first medical contact occurs in centers without a catheterization laboratory, which is an important predictor of delay from diagnosis to artery opening.<br /> (Copyright © 2016 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.)
- Subjects :
- Coronary Angiography mortality
Coronary Angiography statistics & numerical data
Coronary Care Units statistics & numerical data
Emergency Medical Services statistics & numerical data
Female
Humans
Male
Middle Aged
Myocardial Reperfusion mortality
Myocardial Revascularization mortality
Myocardial Revascularization statistics & numerical data
Patient Transfer statistics & numerical data
Registries
Spain epidemiology
Time-to-Treatment
Myocardial Reperfusion statistics & numerical data
ST Elevation Myocardial Infarction mortality
ST Elevation Myocardial Infarction surgery
Subjects
Details
- Language :
- English; Spanish; Castilian
- ISSN :
- 1885-5857
- Volume :
- 70
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- Revista espanola de cardiologia (English ed.)
- Publication Type :
- Academic Journal
- Accession number :
- 28034683
- Full Text :
- https://doi.org/10.1016/j.rec.2016.11.030