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Title: Reperfusion Times and Outcomes in Patients With ST-Elevation Myocardial Infarction Presenting Without Pre-Hospital Notification.
Author: Hamilton, G.
Yeoh, J.
Dinh, D.
Brennan, A.
Yudi, M.
Freeman, M.
Horrigan, M.
Martin, L.
Reid, C.
Yip, T.
Picardo, S.
Sharma, Anand
Duffy, S.
Farouque, O.
Clark, D.
Ajani, A.
Institutional Author: Melbourne Interventional Group
Issue Date: 2022
Publication Title: Cardiovascular Revascularization Medicine
Volume: 41
Start Page: 136
End Page: 141
Abstract: Background Primary percutaneous coronary intervention (PCI) for patients with ST-elevation myocardial infarction (STEMI) is recommended within 90 min of first medical contact. Those without pre-hospital notification (PN) are less likely to meet reperfusion targets and are an understudied subset of the STEMI population. Methods An observational cohort study from a multicentre PCI registry of consecutive patients undergoing primary PCI for STEMI between 2012 and 2017. Exclusion criteria included out-of-hospital cardiac arrest, prior thrombolysis, symptom onset >12 h prior, and cardiogenic shock. Results 2519 patients were included: 1392 (55.3%) without PN (no-PN group) and 1127 (44.7%) with PN (PN group). Those without PN had longer median DTBT (78 min vs 51 min, p < 0.001) and STBT (206 min vs 161 min, p < 0.001), with only 55% meeting DTBT targets out-of-hours in the no-PN group. No-PN patients had lower rates of AHA/ACC type B2/C lesions, GP IIb/IIIa use, aspiration thrombectomy and had smaller stent diameter (all p ≤ 0.003), suggesting smaller areas of ischemic myocardium. There were no significant differences in 30-day MACE (no-PN 5.6% vs PN 6.5%, p = 0.36) or long-term National Death Index linked mortality (no-PN 6.2% vs PN 7.9%, p = 0.09). Lack of PN did not independently predict long-term mortality. Conclusion Despite comparably excellent outcomes overall, those without PN had longer ischemic times and were less likely to meet DTBT targets, especially after hours. Ischemic times may be a better evaluation of PN networks than hard clinical outcomes, and efficient systems of care tailored to the individual health service are essential to ensure timely reperfusion of patients with STEMI. Introduction Timely primary percutaneous coronary intervention (PCI) is known to improve prognosis in patients presenting with ST-elevation myocardial infarction (STEMI) [1]. Local guidelines thus advocate for reperfusion within 90 min of first medical contact [2], [3], and similar recommendations are adopted internationally [4], [5]. As a result, there has been global acceptance of pre-hospital notification (PN) systems to allow catheter laboratory, emergency department, and other staff time to prepare. Despite robust communication networks between hospitals and first responders, there will continue to be self-presenters to the emergency department and patients whose electrocardiograms (ECGs) are non-diagnostic in the field. Patients without PN are less likely to meet reperfusion targets and have significantly longer ischemic times compared to those presenting with PN. However, previous studies focused on the utility of PN have not shown that it improves prognosis [6], [7], [8], [9], [10]. We reviewed the prevalence, characteristics, and outcomes of patients presenting without PN, an important but understudied subset of the contemporary STEMI population.
Internal ID Number: 01934
Type: Journal Article
Appears in Collections:Research Output

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