Bypassing the Emergency Room to Reduce Door‐to‐Balloon Time and Improve Outcomes of ST Elevation Myocardial Infarction Patients: Analysis of Data from 2004–2010 ACSIS Registry

Lubovich, Alla; Dobrecky‐Mery, Idit; Radzishevski, Eugeny; Samnia, Neemer; Matetzky, Shlomi; Nagler, Rafael M.; Rosenschein, Uri

doi:10.1111/joic.12192

Cited by 19 publications

(18 citation statements)

References 15 publications

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“…Based on the most recent ACSIS registry, thrombolytic therapy for acute STEMI is extremely rare in Israel. The standard of care in the vast majority of patients is PPCI [9]. In our series, none received thrombolytic therapy.…”

Section: Discussionmentioning

confidence: 99%

Cardiac Rupture: New Features of the Old Disease

Leitman

Tsatskin²,

Hendler³

et al. 2016

Cardiology

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Objectives: Myocardial rupture is a rare but a fatal complication of acute myocardial infarction. During recent years, treatment strategies of acute myocardial infarction have changed. Primary percutaneous coronary interventions have replaced fibrinolytic therapy, thus reducing one of the major risk factors for myocardial rupture. In this work, we describe a group of patients who suffered myocardial rupture, none of whom were treated with thrombolytic therapy. Methods: The digital database of our hospital was searched for all patients who experienced myocardial rupture between 2008 and 2015. The demographic, clinical, angiographic and echocardiographic data of these patients were analyzed. Results: Out of 2,380 patients admitted with acute myocardial infarction, 12 (0.5%) developed myocardial rupture. The mean age was 78 years, and there were 7 males and 5 females. Ten patients already had pericardial effusion on admission. Seven patients underwent coronary angiography, whilst primary percutaneous intervention was performed in 4 patients. Six patients entered the operating room and all survived the procedure. All patients who were treated conservatively died due to rupture. Factors related to the treatment strategy were advanced age (≥90 years) and cognitive impairment. Conclusions: The risk of myocardial rupture may be diminished by primary coronary intervention during myocardial infarction, but mortality remains high. An early, comprehensive echocardiographic examination and rapid surgery may contribute to improved survival.

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Section: Discussionmentioning

confidence: 99%

Cardiac Rupture: New Features of the Old Disease

Leitman

Tsatskin²,

Hendler³

et al. 2016

Cardiology

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“…It has also been demonstrated that deprived neighborhoods present higher rates of mortality due to IHD [22]–[25]. Studies have investigated whether making reference cardiology services more accessible would ultimately reduce mortality rates [26]–[29]. Despite the extensive information about isolated factors, to our knowledge the interplay among distance from a reference cardiology center, socioeconomic/demographic conditions, and IHD-specific mortality rate have not been evaluated in developing countries.…”

Section: Introductionmentioning

confidence: 99%

Regional Disparities in Mortality after Ischemic Heart Disease in a Brazilian State from 2006 to 2010

Andrade

Zanini²,

Batilana

et al. 2013

PLoS ONE

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BackgroundHigh technology in the field of interventional cardiology applied in tertiary hospitals has brought enormous benefits in the treatment of ischemic heart disease (IHD). However, IHD mortality rates remain high. We analyzed the relationship between IHD mortality rate and the socioeconomic, demographic, and geographic conditions in 399 cities in Parana state, Brazil, from 2006 to 2010.Methods and ResultsData were obtained from the Mortality Information System and the Brazilian Institute of Geography and Statistics and evaluated through Exploratory Spatial Data Analysis. GeoDa™ was used to analyze 29.351 deaths across 399 cities. We found a positive spatial autocorrelation regarding IHD mortality (I = 0.5913, p = 0.001). There was a significant positive association between each of three socioeconomic and demographic indicators and IHD mortality rate: Population Elderly Index (I = 0.3436), Illiteracy Rate (I = 0.1873) and City Development Index (I = 0.0900). In addition, two indicators presented significant negative association with IHD mortality rate: Adjusted Population Size (I = −0.1216) and Gross Domestic Product (I = −0.0864). We also found a positive association between IHD mortality rates and the geographic distances between patients’ city of residence and their corresponding regional referral centers in interventional cardiology (I = 0.3368). Cities located within Regional Health Units with Reference Interventional Cardiology Center presented a significantly lower average specific mortality rate by IHD. The high mortality rate by IHD within the Regional Health Units was not restricted to socioeconomic and demographic variables, but dependent on the distance between each city and their reference interventional cardiology center.ConclusionsWe conclude that geographic factors play a significant role in IHD mortality within cities. These findings have important policy implications regarding the geographic distribution of cardiac health care networks in Latin America and in other emerging countries.

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“…After matching, the median VABT was 8 minutes (interquartile range [IQ] [6][7][8][9][10][11][12]) for the culprit PPCI first group, 12 minutes (IQ [9][10][11][12][13][14][15]) for the contralateral angiography first group, and 14 minutes (IQ [11][12][13][14][15][16][17]) for the complete angiography first group (P<0.001 overall and for trend). The median .001 for trend).…”

Section: What the Study Addsmentioning

confidence: 99%

“…9 Many strategies have been successfully applied to shorten door-to-balloon time before catheterization laboratory arrival but few have been studied to reduce delays inherent to the procedure. [10][11][12][13][14][15][16][17] Hereof, there is scarce data on the impact of obtaining a complete diagnostic angiography before PPCI. Our study sought to determine whether a strategy of performing culprit-vessel revascularization before obtaining contralateral or complete diagnostic angiography could be associated with a reduction in delays and outcomes in ST-segment-elevation myocardial infarction (STEMI) patients.…”

mentioning

confidence: 99%

Culprit Vessel Revascularization Prior to Diagnostic Angiography as a Strategy to Reduce Delays in Primary Percutaneous Coronary Intervention

Couture

Bérubé

Dalery³

et al. 2016

Circ: Cardiovascular Interventions

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were studied. After excluding patients with prior coronary artery bypass surgery, 925 patients were included in the analysis. Patients were classified into 3 groups according to the as-treated revascularization strategy: culprit-vessel revascularization first, contralateral angiography first, or complete angiography first. Propensity score matching was used to minimize difference in clinical characteristics between groups. Predictors of culprit-vessel first revascularization were anterior/lateral infarct location and absence of diabetes mellitus. After propensity score matching, the median vascular access-to-balloon time was 4 to 6 minutes shorter with a culprit-vessel revascularization first strategy. This reduction in time to reperfusion increased the proportion of patients treated within recommended delays. However, there was no significant difference in 30-day clinical outcomes associated with these delays reduction. Conclusions-Performing culprit-vessel primary percutaneous coronary intervention before contralateral or complete diagnostic angiography is associated with a statistically significant reduction in vascular access-to-balloon time, although the 4-to 6-minute difference is unlikely to be clinically relevant. This small but significant reduction could translate in an augmentation in the proportion of patients treated within recommended delays. (Circ Cardiovasc Interv. 2016;9:e003510.

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Bypassing the Emergency Room to Reduce Door‐to‐Balloon Time and Improve Outcomes of ST Elevation Myocardial Infarction Patients: Analysis of Data from 2004–2010 ACSIS Registry

Abstract: Bypassing the ER is associated with significant shortening of DBT. This reduction, however, is not associated with any change in 30-day MACCE and 30-day or 1-year mortality.

Cited by 19 publications

References 15 publications

Cardiac Rupture: New Features of the Old Disease

Cardiac Rupture: New Features of the Old Disease

Regional Disparities in Mortality after Ischemic Heart Disease in a Brazilian State from 2006 to 2010

Culprit Vessel Revascularization Prior to Diagnostic Angiography as a Strategy to Reduce Delays in Primary Percutaneous Coronary Intervention

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