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Door-to-balloon time and mortality of a PCI centre: how crucial can 30 minutes be for our stemi patients?
Session:
CO9 - Doença Coronária
Speaker:
Isabel Campos
Congress:
CPC 2019
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:
Comunicações Orais
FP Number:
---
Authors:
Isabel Durães Campos; Cátia Costa Oliveira; Carlos Galvão Braga; Carla Marques Pires; Paulo Medeiros; Ana Sofia Ferreira; Catarina Vieira; João Costa; Rui Files Flores; Jorge Marques
Abstract
<p><strong>Introduction: </strong>STEMI time delays have been presented as an indicator of quality of care. Considering the system delay, the guidelines of European Society of Cardiology (ESC) and American Heart Association (AHA) for the management of STEMI patients (pts) diverge regarding the maximum time from STEMI diagnosis to wire crossing in pts presenting at primary PCI (pPCI) hospitals (≤ 60min versus ≤ 90min, respectively).</p> <p><strong>Objective: </strong>To compare the prognosis between pts presenting at pPCI hospital with maximum time from STEMI diagnosis to wire crossing of ≤ 60min and patients with times between 61 and 90min.</p> <p><strong>Methods</strong>: The records of 1679 STEMI pts admitted consecutively in our coronary care unit during six years were analysed retrospectively. Of this pts, 341 (20%) were admitted directly in a PCI centre and 1338 (80%) were rescued by an emergency medical system or presented to a non-PCI centre. Pts that presented at PCI centre were divided into two groups: group 1 - STEMI pts with maximum time from STEMI diagnosis to wire crossing of ≤ 60min (n=202 ,69%); group 2 - STEMI pts with times 61-90 min (n=91, 31%). Pts with time from STEMI diagnosis to wire crossing > 90min were excluded. Primary endpoints were the occurrence of death at 6 months and 1 year; follow-up was completed in 98% of pts.</p> <p><strong>Results: </strong>Group 2 pts were older (60±14 vs 67±143, p<0.001), with higher proportion of women (14.9% vs 25.3%, p=0.026), hypertension (45.5% vs 61.5%, p=0.035), diabetes (17.1 vs 24.4%, p=0.005) and presented more frequently Killip 4 at admission (2.1% vs 12.5%, p=0.003). Group 1 pts had higher proportion of smokers (62.2% vs 49.4%, p=0.03). Patient delay was statistically higher in group 2 (Mdn(h) 3.8±3.5 vs 5±2, p<0.001), as was the system delay (Mdn(min) 45±9 vs 74±8, p<0.001). In-hospital mortality (3.8% vs 5.1%, p=0.42) wasn’t different between groups, but at 1-month (3.8% vs 10.3%, p=0.05), 6-months (4.4% vs 12.8%, p=0.02) and 1-year mortality (5% vs 15.4%, p=0.008) was higher in group 2. In multivariate analysis and after adjusting for different baseline characteristics, pts who complied with the recommended times according to the 2017 ESC guidelines had lower risk mortality at 1 year compared to group 2 [HR 0.42, 95% CI (0.23-0.74), p=0.006].</p> <p><strong>Conclusion:</strong> In patients presenting at this PCI centre, complying with the 2017 ESC STEMI guidelines in order to reduce the system delay to ≤ 60min was crucial, since pts who were reperfused within this recommended time had lower mortality rates.</p> <p> </p>
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