| Popis: |
Background In 2013, PPCI was implemented as the reperfusion strategy for STEMI in Ireland. A PPCI strategy may result in increased delays to treatment, which may negate the anticipated benefit of PPCI over fibrinolysis provided in a local hospital. We wished to explore the real world effect of a PPCI strategy on clinical outcomes for a cohort of rural based patients distant from their designated PPCI centre (at a projected 60–90 min transfer time). Methods We conducted this retrospective cohort study at 2 rural hospitals and at a PPCI centre. We identified 2 cohorts of patients with STEMI. The first comprised all patients presenting to the rural hospitals between 01/01/2011 to 31/12/2012 with STEMI (Pre-PPCI cohort). The second comprised all patients from the catchment area of these hospitals presenting with STEMI to the PPCI centre between 01/01/2015 to 31/12/2016 (PPCI cohort). For each cohort we compared baseline characteristics, timeliness of initiation of reperfusion therapy, in hospital mortality, and for patients who survived to discharge the prevalence of LV dysfunction at 180 days. We tested for significance using chi square test. Results We identified 127 STEMI patients (97 M/30F), median age 60.6 (Range 31–94). A door to needle time of less than 30 minutes was achieved in the Pre-PPCI cohort in 68% of eligible patients (n=73) (median 21 mins (IQR 13–31 mins)) and a reperfusion time Conclusions Projected patient transfer times utilised by healthcare planners may underestimate the challenges faced in delivering optimal reperfusion times for rural patients in clinical practice. We found delays to PPCI were commonplace, and overall we did not demonstrate a superiority for PPCI over fibrinolysis in this setting. In light of the trend towards better outcomes for patients directly transferred from the community to the PPCI hospital, a comprehensive strategy of direct transfer needs to be rigorously pursued. |
