Impacto da transferência inter-hospitalar nos resultados da intervenção coronária percutânea primária

Abstract

Background: Delays resulting from the transfer to perform primary percutaneous coronary intervention (PCI) have a negative impact on the benefits of the procedure. Methods: Prospective registry aimed at comparing the results of primary PCI in patients with ST-segment elevation myocardial infarction (STEMI) admitted or transferred to an interventional cath lab equipped hospital. Results: Between February 2009 and December 2011, 319 patients were included in the study with mean age of 59.8 ± 12 years, 28.5% were female and 22.3% were diabetics. Patients transferred for primary PCI (n = 201) had longer door-to-balloon time (86.4 ± 26.6 min vs 69 ± 22.6 min; P < 0.0001), a non-significant decrease in ST-segment elevation resolution (83.5% vs 90.4%; P = 0.18), final TIMI 3 flow (90.1% vs 94.1%; P = 0.30), myocardial blush grade 3 (74.3% vs 78.8%; P = 0.22) and angiographic success (90.1% vs 94.1%; P = 0.30), and a non-significant increase in major bleeding (2% vs 0.9%; P = 0.20) and hospital mortality (6.5% vs 4%; P = 0.29). Conclusions: The referral of patients with STEMI directly to an interventional cath lab equiped hospital is associated with shorter door-toballoon time and non-significant improvement of reperfusion markers and mortality.

Resolução do segmento ST após intervenção coronária percutânea primária: características, preditores de insucesso e impacto na mortalidade

“…The mean ischemia time was 5.1 hours and the median door-to-balloon time was only 55 minutes, favored by the logistical conditions set forth in a previous publication. 10 Moreover, manual aspiration thrombectomy was used in 54% of the sample, and glycoprotein IIb/IIIa inhibitors and adenosine were administered prophylactically to 59% and 36% of cases, respectively.…”

Farmacoterapia antitrombótica intra-hospitalar e aos seis meses após intervenção coronária percutânea primária: Análise do Registro da Prática Clínica em Síndrome Coronária Aguda (ACCEPT)

“…As a caveat to the prescription Glycoprotein IIb/IIIa receptor inhibitors, whose efficacy was demonstrated in studies performed before the routine use of dual antiplatelet therapy, showed a decline in their prescription, compared to previous publications. 13,14 The consolidation of oral dual antiplatelet therapy, the constant search for the balance between anti-ischemic efficacy and safety, as well as the advent of ADP inhibitors with higher power justify this finding, whereas the use of parenteral agents are restricted to specific and rescue situations, such as large thrombotic burden, coronary flow disorders, and thrombotic complications.…”