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Primary PCI in a regional centre - 7 years of change and improvement
Session:
Sessão de Posters 35 - Enfarte agudo do miocárdio com supra ST
Speaker:
Rafael Viana
Congress:
CPC 2024
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:
Cartazes
FP Number:
---
Authors:
Rafael Viana; Marta Figueiredo; Francisco Cláudio; Miguel Carias; António Almeida; Rita Rocha; Gustao Mendes; Diogo Brás; David Neves; Ângela Bento; Renato Fernandes; Lino Patrício
Abstract
<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Ischemic heart disease stands as the predominant cause of mortality. The mortality rate among individuals experiencing an acute coronary syndrome with ST-elevation (STEMI) is influenced by various factors, including the time lapse before treatment, encompassing primary percutaneous coronary angioplasty (PPCI) or fibrinolysis. To enhance the quality of care, it is essential to systematically document and assess treatment delays. We aim to analyse and characterized the times and delays in the emergent coronary referral pathway in our region. </span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">METHODS and RESULTS: Consecutive STEMI patients admitted for PCI in our centre, from 2015 to 2021, were included. We gathered data on following time variables: patient delay, electrocardiogram (ECG) delay, logistic delay, transport delay, home delay, procedure time. These variables enabled calculation of the following time frames: first medical contact (FMC) to diagnosis time, door-in-door out time (DIDO), door to wire, diagnosis to wire, FMC to wire and total ischemia time.</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#374151">Over 7 years, we included a total of 1452 cases, with a median age of 64± 14 years and 75.3%male. The analysis revealed a median patient delay of 90min (interquartil range (IQR) 145), while the ECG delay median was 20min (IQR 47). Median DIDO time was 112min (IQR 151), diagnostic delay was 40min (IQR 40) and FMC to diagnostic time was 80min (IQR 139). The median time of logistic delay was 28min (IQR 54), transport time was 58min (IQR 25) and home delay was 16min(IQR 57). In our population, median procedure time was 28min (IQR 14), door to wire time was 52min (IQR 57), diagnosis to wire time was 87min (IQR 73), FMC to wire time was 194min (IQR 147) and the total ischemia time was 311min (IQR 303).</span></span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">CONCLUSION: Our work shows several points in which there should be a direct intervention in order to improve quality of care. Firstly, the global median time from FMC to diagnosis is still far from the expected target (80 minutes vs 10 minutes in European Society of Cardiology). The median time to perform an ECG is higher than the target. Improving this aspect could involve establishing a dedicated team to promptly conduct ECG assessments in alignment with the patient's symptoms. The diagnosis to wire is more forthcoming with a median of 87min. <span style="color:#374151">In order to reduce logistic and transport delays, establishing a regional transport network for critical patients is crucial. This becomes particularly significant in our geographical area, where considerable distances separate centres lacking hemodynamic facilities and accessibility is suboptimal. </span></span></span></p>
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