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In-hospitalar mortality after STEMI in Portugal: Do patient location affect outcome?
Session:
Posters - H. Interventional Cardiology and Cardiovascular Surgery
Speaker:
André Azul Freitas
Congress:
CPC 2021
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
25. Interventional Cardiology
Subtheme:
25.2 Coronary Intervention
Session Type:
Posters
FP Number:
---
Authors:
André Azul Freitas; José Paulo Almeida; João Rosa; Sofia Martinho; Valdirene Gonçalves; Gustavo Campos; Cátia Ferreira; James Milner; João André Ferreira; Elisabete Jorge; Marco Costa; Lino Gonçalves
Abstract
<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">INTRODUCTION:</span></span></span></p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Portuguese Registry of Acute Coronary Syndromes (PRoACS) reported a sustained decrease of in-hospital STEMI mortality, being 3.4% in 2018, one of the lowest in Europe. In our tertiary centre, serving the biggest referral geographic area in Portugal, a higher mortality has been described. In this study we aimed to assess in-hospital STEMI mortality and to evaluate if the patient origin affected the outcome.</span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">METHODS</span></span></span></p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">We retrospectively assessed all patients submitted to coronarography due to STEMI between January 2019 and July 2019. From 195 procedures, 163 patients had criteria for myocardial infarction according to the international definition and were included in our analysis. Patient characteristics, pattern of emergency admission (including referring hospital) and outcomes were evaluated.</span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">RESULTS</span></span></span></p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Mean age was 64.7<span style="font-family:Symbol">±</span> 12.6 years with 79% being male. In-hospital mortality was 9.8% and it was 12.3% at 6 months. Transference from a non-PCI centre occurred in 38.7% with 46% of them being transferred again to the referring hospital. Patients from non-PCI centre had similar patients’ characteristics. However, they showed an increase in system delay (183.9 <span style="font-family:Symbol">±</span>242 min vs 91.1 <span style="font-family:Symbol">±</span> 92 min, P=0.005), a lower ejection fraction at hospital discharge (40.7% <span style="font-family:Symbol">±</span> 10.9% vs 47.5% <span style="font-family:Symbol">±</span>8.5%, P=0.001) and less chance to have a non-culprit coronary lesion to be treated (11.7% vs 27.3%, P=0.02). Nevertheless, there were no differences regarding in-hospital (7.9% vs 11%, P=0.185) or 6-month mortality (11.1% vs 13%, P=0.273).</span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">CONCLUSIONS</span></span></span></p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">In our hospital, in-hospital mortality after STEMI is similar to the reported values in European countries but it is substantially higher than the ones reported by PRoACS. Transferred patients from a non-PCI hospital may have a higher system delay and a consequently worse prognosis, but they do not seem to have an increased short-term mortality. </span></span></span></p>
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