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Predictors of primary percutaneous coronary intervention delay in cases of myocardial infarction diagnosed in hospitals without hemodynamic support systems




Carol Ruiz A, Masip Utset J, Ariza-Solé A, Gómez-Hospital JA, Carrillo X, Tizón H, García-Picart J, Regueiro A, Muñoz-Camacho JF, Lidón RM, Jiménez Fàbrega X, Mauri F



Unidad de Hospitalización, Servicio de Cardiología, Hospital Moisés Broggi, Sant Joan Despí, Barcelona, Spain. Servicio de Medicina Intensiva, Hospital Moisés Broggi, Sant Joan Despí, Barcelona, Spain. Unidad de Cuidados Intensivos Cardiológicos, Servicio de Cardiología, Hospital de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain. Unidad de Cardiología Intervencionista, Servicio de Cardiología, Hospital de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain. Unidad de Cardiología Intervencionista, Servicio de Cardiología, Hospital GermansTrias i Pujol, Badalona, Barcelona, Spain. Unidad de Cardiología Intervencionista, Servicio de Cardiología, Hospital del Mar, Barcelona, Spain. Unidad de Cardiología Intervencionista, Servicio de Cardiología, Hospital de Santa Creu i Sant Pau, Barcelona, Spain. Unidad de Cardiología Intervencionista, Servicio de Cardiología, Hospital Clinic, Barcelona, Spain. Unidad de Cardiología Intervencionista, Servicio de Cardiología, Mutua de Terrassa, Terrassa, Barcelona, Spain. Unidad de Cuidados Agudos Cardiológicos, Servicio de Cardiología, Hospital de Valld’Hebron, Barcelona, Spain. Sistema d’Emergències Mèdiques, Barcelona, Spain. Directora Pla Director Malaties Cardiovasculars, Departament de Salut, Generalitat de Catalunya, Barcelona, Spain.



Objetive. The need for primary percutaneous coronary intervention in hospitals without hemodynamic support capability is associated with delays between first medical contact (FMC) and reperfusion. It is important to identify factors involved in delays, particularly if they are relevant to the organization of emergency services.
Methods. Analysis of a registry of patients treated in hospitals without advanced hemodynamic support systems in a catchment area with an established care network for acute ST-segment elevation myocardial infarction (STEMI). The registry included care times.
Results. The network served 2542 patients with a mean (SD) age of 63 (13) years. FMC-to-reperfusion time was within 120 minutes in 42% of the cases. Nine of the hospitals had a chest-pain unit in the emergency department, and this factor was an independent predictor of FMC-to-reperfusion times of 120 minutes or less (odds ratio, 0.64; 95% CI, 0.54–0.77; P < .0001); the time was shortened by 11 minutes in such hospitals. FMC-to-reperfusion was delayed beyond 120 minutes in relation to the following factors: shock and need for intubation at start of care, age, gender, FMC at night, left bundle branch block, and Killip class. One-month and 1-year mortality rates increased in hospitals without hemodynamic support systems in proportion to reperfusion delay, by 1.7% and 3.5% if the delay was 106 minutes or less and by 7.3% and 12.4% if the delay was 176 minutes or longer (P < .0001).
Conclusions. FMC-to-reperfusion time in STEMI exceeds recommendations in 58% of the hospitals without hemodynamic support systems and delay is inversely proportional to the availability of an emergency department chest pain unit. One-month and 1-year mortality is proportional to the degree of delay.


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