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Curso de Atualização em Medicina Cardiovascular 2019
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ST elevation myocardial infarction network – portrait of a country.
Session:
CO - Prémio Jovem Investigador (Investigação Clínica)
Speaker:
Joao Pedro Tuna Moura Guedes
Congress:
CPC 2019
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
25. Interventional Cardiology
Subtheme:
25.2 Coronary Intervention
Session Type:
Comunicações Orais
FP Number:
---
Authors:
João Pedro Moura Guedes; Pedro Oliveira De Azevedo; João De Sousa Bispo; Teresa Faria Da Mota; Raquel Menezes Fernandes; Nuno Marques; Walter Santos; Jorge Mimoso; Ilidio Paulos De Jesus
Abstract
<p><strong>Introduction:</strong> Primary angioplasty (PA) is a cornerstone in the ST elevation myocardial infarction (STEMI) treatment. Time is myocardium and STEMI network was designed to reduce time lost and offer PA as early as possible</p> <p><strong>Purpose: </strong>To characterize STEMI network in a country and its regions and identify independent predictors (IP) to increase or decrease the times symptoms-1st ECG (S-ECG), 1st ECG - balloon (ECG-B), symptoms-balloon (S-B) and door-to-balloon.</p> <p><strong>Methods:</strong> Retrospetive and multicenter study, based on a national register from 30/10/2010 to 09/19/2017. All patients with revascularized STEMI within the first 12 h of pain were included. 4 groups were established: North (I); Center (II); South (III); Algarve and Islands (IV). Univariate and multivariate analysis was performed of the clinical history, times until PA and hospitalization data.</p> <p><strong>Results: </strong>It was obtained 4683 patients, 1401 of I (29.9%), 971 of II (20.7%), 1033 of III (22.1%) and 1278 of IV (27.3%). The mean age was 62 years and 77% were men.</p> <p>Admission by STEMI network was performed in 36.2% of cases in country, 38.0% in I, 20.1% in II, 23.4% in III and 56.3% in IV. Direct admission in cath lab was 41.3%, 48.6% in I, 30.1% in II, 12.6% in III and 64.8% in the IV.</p> <p>S-ECG time was 158 minutes (m) in country, 155m in I, 187m in II, 161m in III and 138m in IV. IP for increase S-ECG time were transport through own or ambulance without doctor, females (FS), increased age (IA) and belong to group II (p<0.01). The admission by STEMI network was IP for decrease S-ECG time (p<0.01).</p> <p>ECG-B time was 121m, 124m in I, 134m in II, 116m in III and 111m in IV. IP for increase ECG-B time were transfer from another hospital, admission in coronary care unit (CCU) or emergency service and IA (p<0.01). Belonging to group IV was IP for decrease ECG-B time (p<0.01).</p> <p>S-B time was of 279m, 279m in I, 320m in II, 277m in III and 249m in IV. IP for increase S-B time were transport through own or ambulance without doctor, transfer from another hospital, FS, IA, belonging to group II (p<0.01) and admission in CCU. Direct admission in cath lab was IP for decrease S-B time.</p> <p>P-B time was 98m, 103m in I, 123m in II, 119m in III and 54m in IV. IP for increase S-B time were transfer from another hospital, admission in the emergency service, FS and IA (p<0.01). Medical transport, admission by STEMI network and belong to groups I and IV were IP for decrease P-B time (p<0.01).</p> <p><strong>Conclusion:</strong></p> <p>STEMI network admission and admission in cath lab were IP to decrease times until PA. By contrast, transport by other means, admission at other locations, FS and IA were IP to its increase.</p> <p>Northern and Algarve and Islands regions had a STEMI network more effectively than the rest of the country being IP in the decrease P-B (North and Algarve and islands) and ECG-B (Algarve and islands) times.</p> <p>Central region is one that requires greater intervention and restructuring because it is where the S-ECG and S-B times were significantly higher.</p>
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