The tradeoff between travel time from home to hospital and door to balloon time in determining mortality among STEMI patients undergoing PCI
| Autor: | Nera Agabiti, Giovanna Cappai, Valeria Belleudi, Carlo A. Perucci, Paolo Sciattella, Danilo Fusco, Marina Davoli, Roberto Ricci, Francesca Mataloni, Riccardo Di Domenicantonio, Mirko Di Martino |
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| Jazyk: | angličtina |
| Rok vydání: | 2016 |
| Předmět: |
Male
Emergency Medical Services Critical Care and Emergency Medicine medicine.medical_treatment Myocardial Infarction Coronary lcsh:Medicine Blood Pressure Comorbidity 030204 cardiovascular system & hematology Vascular Medicine 0302 clinical medicine Mathematical and Statistical Techniques Risk Factors Emergency medical services Medicine and Health Sciences 80 and over Medicine 030212 general & internal medicine Myocardial infarction Adult Aged Aged 80 and over Female Humans Italy Middle Aged Retrospective Studies ST Elevation Myocardial Infarction Angioplasty Balloon Coronary Percutaneous Coronary Intervention Time-to-Treatment lcsh:Science Multidisciplinary Cohort Physical Sciences Regression Analysis Health Services Research Statistics (Mathematics) Research Article medicine.medical_specialty Patients Cardiology Medical Services Research and Analysis Methods 03 medical and health sciences Statistical Methods Intensive care medicine business.industry lcsh:R Angioplasty Percutaneous coronary intervention Retrospective cohort study Emergency department medicine.disease Health Care Emergency medicine Conventional PCI Reperfusion Door-to-balloon lcsh:Q business Mathematics Balloon |
| Zdroj: | PLoS ONE PLoS ONE, Vol 11, Iss 6, p e0158336 (2016) |
| Popis: | Background In ST-segment elevation myocardial infarction (STEMI), even in presence of short door to balloon time (DTBT), timely reperfusion with percutaneous coronary intervention (PCI) is hampered by pre-hospital delays. Travel time (TT) constitutes a relevant part of these delays and may contribute to worse outcomes. Objective To evaluate the relationship between TT from home to hospital and DTBT on 30-day mortality after PCI among patients with STEMI. Methods We enrolled a cohort of 3,608 STEMI patients with a DTBT within 120 minutes who underwent PCI between years 2009 and 2013 in Lazio Region (Italy). We calculated the minimum travel time from residential address to emergency department where the first medical contact occurred. We defined system delay as the sum of travel time and DTBT time. Logistic regression models, including clinical and demographic characteristics were used to estimate the effect of TT and DTBT on mortality. Results Among patients with 0–90 minutes of system delay, TT above the median value is positively associated with mortality (OR = 2.46; P = 0.009). Survival benefit associated with DTBT below the median results only among patients with TT below the median (OR for DTBT below the median = 0.39; P = 0.013), (OR for interaction between TT and DTBT = 2.36; p = 0.076). Conclusion TT affects survival after PCI for STEMI, even in the presence of health care systems compliant with current guidelines. Results emphasize the importance of health system initiatives to reduce pre-hospital delay. Utilization of TT can contribute to a better estimate of patient mortality risk in the evaluation of quality of care. |
| Databáze: | OpenAIRE |
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