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Implementation of a Comprehensive ST-Elevation Myocardial Infarction Protocol Improves Mortality Among Patients With ST-Elevation Myocardial Infarction and Cardiogenic Shock
- Source :
- The American Journal of Cardiology. 134:1-7
- Publication Year :
- 2020
- Publisher :
- Elsevier BV, 2020.
-
Abstract
- Mortality in patients with STEMI-associated cardiogenic shock (CS) is increasing. Whether a comprehensive ST-elevation myocardial infarction (STEMI) protocol (CSP) can improve their care delivery and mortality is unknown. We evaluated the impact of a CSP on incidence and outcomes in patients with STEMI-associated CS. We implemented a 4-step CSP including: (1) Emergency Department catheterization lab activation; (2) STEMI Safe Handoff Checklist; (3) immediate catheterization lab transfer; (4) and radial-first percutaneous coronary intervention (PCI). We studied 1,272 consecutive STEMI patients who underwent PCI and assessed for CS incidence per National Cardiovascular Data Registry definitions within 24-hours of PCI, care delivery, and mortality before (January 1, 2011, to July 14, 2014; n = 723) and after (July 15, 2014, to December 31, 2016; n = 549) CSP implementation. Following CSP implementation, CS incidence was reduced (13.0% vs 7.8%, p = 0.003). Of 137 CS patients, 43 (31.4%) were in the CSP group. CSP patients had greater IABP-Shock II risk scores (1.9 ± 1.8 vs 2.8 ± 2.2, p = 0.014) with otherwise similar hemodynamic and baseline characteristics, cardiac arrest incidence, and mechanical circulatory support use. Administration of guideline-directed medical therapy was similar (89.4% vs 97.7%, p = 0.172) with significant improvements in trans-radial PCI (9.6% vs 44.2%, p < 0.001) and door-to-balloon time (129.0 [89:160] vs 95.0 [81:116] minutes, p = 0.001) in the CSP group, translating to improvements in infarct size (CK-MB 220.9 ± 156.0 vs 151.5 ± 98.5 ng/ml, p = 0.005), ejection fraction (40.8 ± 14.5% vs 46.7 ± 14.6%, p = 0.037), and in-hospital mortality (30.9% vs 14.0%, p = 0.037). In conclusion, CSP implementation was associated with improvements in CS incidence, infarct size, ejection fraction, and in-hospital mortality in patients with STEMI-associated CS. This strategy offers a potential solution to bridging the historically elusive gap in their care.
- Subjects :
- Male
medicine.medical_specialty
medicine.medical_treatment
Shock, Cardiogenic
Hemodynamics
030204 cardiovascular system & hematology
Time-to-Treatment
03 medical and health sciences
Extracorporeal Membrane Oxygenation
Percutaneous Coronary Intervention
0302 clinical medicine
Clinical Protocols
Internal medicine
parasitic diseases
medicine
Humans
Hospital Mortality
cardiovascular diseases
030212 general & internal medicine
Myocardial infarction
Aged
Ejection fraction
Aspirin
business.industry
Cardiogenic shock
Incidence (epidemiology)
Anticoagulants
Disease Management
Percutaneous coronary intervention
Stroke Volume
Emergency department
Middle Aged
medicine.disease
Checklist
Treatment Outcome
Radial Artery
Conventional PCI
Purinergic P2Y Receptor Antagonists
Cardiology
ST Elevation Myocardial Infarction
Female
Emergency Service, Hospital
Cardiology and Cardiovascular Medicine
business
Platelet Aggregation Inhibitors
Subjects
Details
- ISSN :
- 00029149
- Volume :
- 134
- Database :
- OpenAIRE
- Journal :
- The American Journal of Cardiology
- Accession number :
- edsair.doi.dedup.....8275fb12437956a8af138f72e85f8aeb