Predictors of Late Reperfusion in STEMI Patients Undergoing Primary Angioplasty. Impact of the Place of First Medical Contact
a Servicio de Cardiología, Unidad de Hospitalización, Hospital Moisés Broggi, Consorci Sanitari Integral (CSI), Sant Joan Despí, Barcelona, Spain
b Servicio de Medicina Intensiva, Hospital Moisés Broggi, Consorci Sanitari Integral (CSI), Sant Joan Despí, Barcelona, Spain
c Servicio de Cardiología, Unidad de Cuidados Agudos Cardiológicos, Hospital Universitario de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
KeywordsMyocardial infarction. Reperfusion. Coronary angiography. Coronary angioplasty. First medical assistance.
AbstractIntroduction 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.Methods
Analysis of the Codi Infart registry of Catalonia and of the time to angioplasty depending on the place of first medical contact.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 42 minutes in both (overall 35 minutes); first medical contact to artery opening time was 131 and 143 minutes, respectively (overall 121 minutes); total ischemia time was 230 and 260 minutes (overall 215 minutes). First medical contact to artery opening time > 120 minutes 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.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.
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