Delays in Primary Percutaneous Coronary Intervention in ST-Segment Elevation Myocardial Infarction Patients Presenting With Cardiogenic Shock

Autor: Christopher B. Fordyce, James G. Jollis, Shannon M. Doerfler, Christopher B. Granger, Ajar Kochar, Jay Shavadia, Hussein R. Al-Khalidi, Steen Møller Hansen, Timothy D. Henry, Peter B. Berger, Mayme L. Roettig, Bernard J. Gersh
Rok vydání: 2018
Předmět:
Male
First medical contact
medicine.medical_specialty
Time Factors
medicine.medical_treatment
Shock
Cardiogenic
030204 cardiovascular system & hematology
Logistic regression
Time-to-Treatment
Workflow
03 medical and health sciences
0302 clinical medicine
Percutaneous Coronary Intervention
Risk Factors
Internal medicine
medicine
ST segment
Humans
cardiovascular diseases
030212 general & internal medicine
Myocardial infarction
Registries
Practice Patterns
Physicians'
Aged
Quality Indicators
Health Care
business.industry
Cardiogenic shock
Percutaneous coronary intervention
Middle Aged
medicine.disease
Quality Improvement
United States
Treatment Outcome
Practice Guidelines as Topic
Cardiology
ST Elevation Myocardial Infarction
Female
Guideline Adherence
Cardiology and Cardiovascular Medicine
business
Zdroj: JACC. Cardiovascular interventions. 11(18)
ISSN: 1876-7605
Popis: This study sought to examine whether quality improvement initiatives across multiple ST-segment elevation myocardial infarction (STEMI) systems translated to faster first medical contact (FMC)-to-device times for patients presenting with cardiogenic shock (CS).There are limited data describing contemporary rates of achieving guideline-directed FMC-to-device times for STEMI patients with CS.From 2012 to 2014, the American Heart Association Mission: Lifeline STEMI Systems Accelerator project established a protocol-guided approach to STEMI reperfusion systems in 484 U.S. hospitals. The study was stratified by CS versus no CS at presentation and performed Cochrane-Armitage tests to evaluate trends of achieving FMC-to-device time targets. A multivariable logistic regression model assessed the association between achieving guideline-directed FMC-to-device times and mortality.Among 23,785 STEMI patients, 1,993 (8.4%) experienced CS at presentation. For direct presenters, patients with CS were less likely to achieve the 90-min FMC-to-device time compared with no-CS patients (37% vs. 54%; p 0.001). For transferred patients, CS patients were even less likely to reach the 120-min FMC-to-device time compared with no-CS patients (34% vs. 47%; p 0.0001). The Accelerator intervention did not result in improvements in the FMC-to-device times for direct-presenting CS patients (p for trend = 0.53), although there was an improvement for transferred patients (p for trend = 0.04). Direct-presenting patients arriving within 90 min had lower mortality rates compared with patients who reached after 90 min (20.49% vs. 39.12%; p 0.001).Fewer than 40% of STEMI patients presenting with CS achieved guideline-directed FMC-to-device targets; delays in reperfusion for direct-presenting patients were associated with higher mortality.
Databáze: OpenAIRE
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