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ECG to reperfusion time analysis ant its impact in the prognosis of Acute Myocardial Infarction.
Session:
Painel 6 - Doença Coronária 13
Speaker:
Cátia Costa Oliveira
Congress:
CPC 2020
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:
Cátia Costa Oliveira; Carlos Galvão Braga; Isabel Durães Campos; Paulo Medeiros; Carla Rodrigues; Rui Files Flores; Fernando Ribeiro Mané; Pedro Azevedo; Miguel Álvares Pereira; António Coelho Gaspar; Jorge Marques; Em nome dos investigadores do registo nacional de Síndromes Coronários Agudos
Abstract
<p><strong>INTRODUCTION:</strong> According to 2017 ESC guidelines for STEMI, reperfusion time of patients not admitted in centers with primary PCI must be ≤120 minutes (min).</p> <p><strong>OBJECTIVE:</strong> To analyze the proportion of patients with STEMI admitted in hospitals without primary PCI in which reperfusion time was ≤120 min and to understand its prognostic impact.</p> <p><strong>METHODS:</strong> Multicentric, retrospective study. 1909 STEMI pts with <12h of symptoms evolution, admitted in hospitals without primary PCI between October 2010 and September 2019 who underwent primary PCI were analyzed. Patients were studied according to the ECG-reperfusion time: ≤120 min (Group 1 – G1) or >120 min (Group 2 – G2).</p> <p><strong>RESULTS:</strong> G1 corresponded to 42.5% while G2 to 57,5%. In both groups patients were mainly male. G1 1 was younger (61±13 vs 64±14, p<0.001) and had more prevalence of smoker patients (44.1% vs 36.1%, p<0.001). G2 have more often diabetes (25.9 % vs 21.2%, p=0.02). Time until the 1<sup>st</sup> medical contact and admission was longer in G2 (120 min vs 105 min, p=0.004). <em>“Via verde coronária”</em> was more frequently activated in G1 (5.5% vs 1.8%, p<0.001). There were no significant differences on the KK classification on admission, but G2 had more prevalence of severe left ventricular disfunction (LVEF≤30%: G1=3%, G2=6%, p=0.002). During the hospitalization, G2 had significantly higher rates of heart failure (11.7% vs 17.4%, p<0.001) and cardiogenic shock (3.6% vs 5.7%, p=0.036). Cardiac arrest on admission was more prevalent in G2 (3% vs 5.2%, p=0.017). Mortality during hospitalization was higher in G2 (1.6 vs 4.2%, p<0.001). Patients admitted on North were mainly in G2 (n=493, 39.6% vs 60.4%) as on Center (n=253, 25.7% vs 74.3%) and South (n=304, 35.3% vs 64.7%). In Lisbon and Tejo Valley patients were mainly on G1 (n=860, 51.6% vs 48.4%). Follow-up was performed in 859 patients (G1=42.6% vs G2=54.4%). After 1 year, there were no differences in mortality (G1=16 deaths, G2=26 deaths, p=0.520). Cardiovascular and non-cardiovascular readmissions were also not difference between the groups mortality (p=0.782 and p=0.548, respectively).</p> <p><strong>CONCLUSION:</strong> Most of the patients did not comply the current guidelines. Reduction of system delay in STEMI remains crucial, since lower reperfusion time have less in-hospital complications and mortality. Follow-up was not performed in all patients which can justify the results. This work shows that it is fundamental to adopt organizational measures to reduce system delay.</p>
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