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STEMI treatment in remote locations: an uncommon reality
Session:
Posters (Sessão 4 - Écran 6) - Doença Coronária e Cuidados Intensivos 5 - EAMcST
Speaker:
M. Inês Barradas
Congress:
CPC 2022
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
13. Acute Coronary Syndromes
Subtheme:
13.4 Acute Coronary Syndromes – Treatment
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
m. Inês Barradas; Fabiana Duarte; Luís Resendes de Oliveira; Cátia Serena; António Xavier Fontes; André Viveiros Monteiro; Carina Machado; Raquel Dourado; Emília Santos; Nuno Pelicano; Miguel Pacheco; Anabela Tavares; Dinis Martins
Abstract
<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri"><span style="color:#000000"><span style="font-size:11pt">Background: In remote locations, lack of specialized medical facilities, long distance transfer and emergency medical system organization remains a challenge and fibrinolysis is necessary to achieve revascularization in optimal timing in ST-elevation myocardial infarction (STEMI) patients. Our angioplasty center is the only one located in a remote region composed of several locations, some of which do not have hospital facilities and only have small family health care units.</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri"><span style="color:#000000"><span style="font-size:11pt">Purpose: To evaluate the reality and outcomes of our interventional angioplasty center and compare cardiovascular outcomes between STEMI patients from the central hospital and remote locations. </span></span></span></span></p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri"><span style="color:#000000"><span style="font-size:11pt">Methods: We retrospectively enorolled 121 consecutive patients with STEMI admitted to our center during one year. Patients from the locality where the center is situated underwent primary percutaneous coronary intervention (PCI) (group 1, n=75) and patients from remote locations underwent fibrinolysis followed by transference to our center with facilitated or rescue PCI (group 2, n=41). A subanalysis of the far remote locations was performed. Primary outcome was defined as cardiovascular (CV) death or re-infarction at 2 years and secondary outcome as intrahospital haemorrhagic complications.</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri"><span style="color:#000000"><span style="font-size:11pt">Results: Mean age was 58,27 ± 12,67 years, 84,3% were males and mean follow up was 30,75 ± 6,44 months. Sixty-seven patients (55,4%) were active smokers, 53 (43,8%) had dyslipidaemia, 24 (19,8%) obesity, 22 (18,2%) previous acute coronary syndrome and 22 (18,2%) diabetes. Troponin I peak was 126,35 ± 150,73 ug/L and 16 (13,2%) were in Killip Class III/IV. Infarct-related artery was the left anterior descending artery in 57 (47,1%) and multivessel disease was present in 48 (39,6%). In group 1 reperfusion after PCI was achieved in 92,0%. In group 2, 68,3% met criteria for reperfusion after fibrinolysis and 22,0% after rescue PCI. Mean time from fibrinolysis to PCI was 654 ± 869 minutes. Rates of successful revascularization did not differ between groups, as well as complete patency of the culprit-vessel defined as thrombolysis in myocardial infarction (TIMI) flow 3 (91,9% vs. 88,9% and 89,2% vs. 94,4% respectively for group 1 and 2). CV death at two years occurred in 4 (3,3%) patients and re-infarction in 12 (9,9%), similar between groups (3 (4,0%) vs. 1 (2,5%) and 7 (9,3%) vs. 5 (12,2%) respectively) as well as minor (2 (2,7%) vs 1 (2,4%)) and major (7 (9,3%) vs. 4 (9,8%)) haemorrhagic complications. Twenty-two (18,2%) patients were from far remote locations without hospital facilities and when comparing these patients with the others there was also no difference in primary outcome. </span></span></span></span></p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri"><span style="color:#000000"><span style="font-size:11pt">Conclusion: Even in remote locations, an organized STEMI network with attempted fibrinolytic treatment and coordinated transference to a PCI center can provide successful revascularization with CV outcomes similar to those submitted to primary PCI.</span></span></span></span></p>
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