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Curso de Atualização em Medicina Cardiovascular 2019
Reunião Anual Conjunta dos Grupos de Estudo de Cirurgia Cardíaca, Doenças Valvulares e Ecocardiografia da SPC
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A. Basics
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01. History of Cardiology
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05. Atrial Fibrillation
06. Supraventricular Tachycardia (non-AF)
07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
09. Device Therapy
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20. Congenital Heart Disease and Pediatric Cardiology
21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
22. Aortic Disease
23. Peripheral Vascular and Cerebrovascular Disease
24. Stroke
25. Interventional Cardiology
26. Cardiovascular Surgery
27. Hypertension
28. Risk Factors and Prevention
29. Rehabilitation and Sports Cardiology
30. Cardiovascular Disease in Special Populations
31. Pharmacology and Pharmacotherapy
32. Cardiovascular Nursing
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34. Public Health and Health Economics
35. Research Methodology
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Does complying guidelines matter?
Session:
Posters 3 - Écran 03 - Isquemia/SCA
Speaker:
Isabel Campos
Congress:
CPC 2018
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
13. Acute Coronary Syndromes
Subtheme:
13.2 Acute Coronary Syndromes – Epidemiology, Prognosis, Outcome
Session Type:
Posters
FP Number:
---
Authors:
Isabel Durães Campos; Ana Ferreira; João Costa; Carlos Galvão Braga; Glória Abreu; Catarina Quina Rodrigues; Cátia Costa Oliveira; Catarina Vieira; Jorge Marques
Abstract
<p><strong>Introduction: </strong>Time until reperfusion since symptoms onset in STEMI patients (pts) can be a matter of life and death, being used as an indicator or marker of quality of care.</p> <p><strong>Objective: </strong>To compare the differences in the prognosis among pts who comply and do not comply with the recommended times according to the 2017 ESC guidelines for the management of acute myocardial infarction in patients presenting with STEMI.</p> <p><strong>Methods:</strong> We analysed retrospectively 1222 STEMI pts admitted in our coronary care unit during five years. The recommended times by the ESC guidelines are: maximum time from STEMI diagnosis to wire crossing in pts presenting at PCI hospitals ≤60min; maximum time from STEMI diagnosis to wire crossing in pts not presenting at primary PCI hospitals ≤120min. Pts were divided into two groups: group 1 - STEMI pts within the recommended times by the ESC guidelines (n=464, 38%); group 2 - STEMI pts without the recommended times by the ESC guidelines (n=758, 62%). Primary endpoint was the occurrence of death at 30 days, 6 months and 1 year; follow-up was completed in 100% of patients.</p> <p><strong>Results: </strong>Of the 1222 STEMI pts analysed, 248 (18.8%) were admitted directly in a PCI centre and 974 (81.2%) were rescued by an emergency medical system (EMS) or presented to a non-PCI centre. Regarding the times recommended by the 2017 ESC guidelines: 76 (30.6%) pts admitted in a PCI centre were revascularized in ≤60minutes; and 388 (39.8%) pts rescued by EMS or admitted in a non-PCI centre were revascularized ≤120 minutes. Group 1 pts were younger (59±13 vs 63±14; p<0.001), had higher proportion of men (81.9% vs 75.6%; p=0.012) and history of smoking (60.7% vs 49.1%; p<0.001). Group 2 pts had higher proportion of hypertension (47.2% vs 53.7%, p=0.031), diabetes (17.1 vs 24.4%, p=0.005), presented more frequently Killip 4 at admission (2.6% vs 5.1%, p=0.043), and left ventricular dysfunction (LVEF<40%) (31% vs 37.9%, p=0.018). Patient delay was statistically higher in group 2 (Mdn (min) 70±107 vs 101±122, p<0.001). At 30 days, (2,4% vs 8.7%, p<0.001), 6-month (3.2% vs 11.6%, p<0.001) and 1 year (4.5% vs 13.6%, p<0.001) mortality was higher in patients who did not comply with the recommended times according to the 2017 ESC guidelines. In multivariate analysis and after adjusting for different baseline characteristics, patients who complied with the recommended times according to the 2017 ESC guidelines had lower risk of 1 year mortality compared to those who did not comply [HR 0.42, 95% CI (0.23-0.74), p=0.003].</p> <p><strong>Conclusion:</strong> Complying with the guidelines recommendations to reduce system delay during STEMI treatment remains crucial, since patients who are reperfused within the recommended time have lower mortality. Thus, it is fundamental to adopt organizational measures to reduce system delay and strengthen health care educational programmes to reduce patient delay, still the greatest delay in the treatment of STEMI.</p> <p> </p>
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