Comparative care and outcomes for acute coronary syndromes in Central and Eastern European Transitional countries: A review of the literature

Smith, Fraser G D; Brogan, Richard; Alabas, Oras; Laut, Kristina Grønborg; Quinn, Tom; Bugiardini, Raffaele; Gale, Chris P

doi:10.1177/2048872614551545

Cited by 24 publications

(21 citation statements)

References 45 publications

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“…However, the limited accessibility of hospitals with 24-7 PPCI capability is a significant obstacle to widespread use of PPCI, and only few countries have been able to offer PPCI to all patients with STEMI, Figure 1 [10][11][12]. In urban areas PPCI service is within reach for most patients, whereas offering PPCI to patients in rural areas is a challenge.…”

Section: Prehospital Ecg Diagnosis Of Patients With St Elevation Myocmentioning

confidence: 99%

Prehospital diagnosis of patients with acute myocardial infarction

et al. 2016

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Primary percutaneous intervention (PPCI) is the preferred treatment in patients with ST elevation myocardial infarction (STEMI) if this can be performed in a timely manner. The 2012 ESC Guidelines on management of AMI in patients presenting with ST-segment elevation advice that PPCI should be performed within 120 min of first medical contact. Prehospital diagnosis of patients with STEMI is performed to save time and make PPCI available to the majority of patients. Although diagnosing patients with STEMI is usually easy, there are important pitfalls and patients with STEMI are missed on occasion. In addition, it is well know that patients without ST elevation may also have a high-risk cardiac condition. The 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation stress the importance of urgent CAG in patients with high-risk non ST-segment elevation myocardial infarction (NSTEMI). Unfortunately, these patients are difficult to diagnose in the acute phase and important time may be spend establishing the correct diagnosis. Prehospital biomarker measurement has emerged as a method to gain important additional information. We review the evidence on prehospital diagnosis of patients with STEMI and, In addition, we present the current knowledge on the new diagnostic methods that could have a future role in prehospital rule-in and rule-out of cardiac disease.

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Section: Prehospital Ecg Diagnosis Of Patients With St Elevation Myocmentioning

confidence: 99%

Prehospital diagnosis of patients with acute myocardial infarction

et al. 2016

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“…Many countries do not yet provide PPCI as the treatment of choice for the emergency reperfusion of STEMI. 16–20 Contemporary knowledge about the barriers and enablers of PPCI implementation will be essential to the future effective provision of nationwide services.…”

Section: Introductionmentioning

confidence: 99%

Patient and hospital determinants of primary percutaneous coronary intervention in England, 2003–2013

Hall

Laut

Dondo

et al. 2016

Heart

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ObjectivePrimary percutaneous coronary intervention (PPCI) for ST-elevation myocardial infarction (STEMI) is insufficiently implemented in many countries. We investigated patient and hospital characteristics associated with PPCI utilisation.MethodsWhole country registry data (MINAP, Myocardial Ischaemia National Audit Project) comprising PPCI-capable National Health Service trusts in England (84 hospital trusts; 92 350 hospitalisations; 90 489 patients), 2003–2013. Multilevel Poisson regression modelled the relationship between incidence rate ratios (IRR) of PPCI and patient and trust-level factors.ResultsOverall, standardised rates of PPCI increased from 0.01% to 86.3% (2003–2013). While, on average, there was a yearly increase in PPCI utilisation of 30% (adjusted IRR 1.30, 95% CI 1.23 to 1.36), it varied substantially between trusts. PPCI rates were lower for patients with previous myocardial infarction (0.95, 0.93 to 0.98), heart failure (0.86, 0.81 to 0.92), angina (0.96, 0.94 to 0.98), diabetes (0.97, 0.95 to 0.99), chronic renal failure (0.89, 0.85 to 0.90), cerebrovascular disease (0.96, 0.93 to 0.99), age >80 years (0.87, 0.85 to 0.90), and travel distances >30 km (0.95, 0.93 to 0.98). PPCI rates were higher for patients with previous percutaneous coronary intervention (1.09, 1.05 to 1.12) and among trusts with >5 interventional cardiologists (1.30, 1.25 to 1.34), more visiting interventional cardiologists (1–5: 1.31, 1.26 to 1.36; ≥6: 1.42, 1.35 to 1.49), and a 24 h, 7-days-a-week PPCI service (2.69, 2.58 to 2.81). Half of the unexplained variation in PPCI rates was due to between-trust differences.ConclusionsFollowing an 8 year implementation phase, PPCI utilisation rates stabilised at 85%. However, older and sicker patients were less likely to receive PPCI and there remained between-trust variation in PPCI rates not attributable to differences in staffing levels. Compliance with clinical pathways for STEMI is needed to ensure more equitable quality of care.

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“…It provides decreased mortality in terms of early management of ACS. There are many various protocols such as chest pain units for early management of ACS on the aim of reducing mortality rates (4,8). The first step of these protocols always begins diagnosis stage in the ED by emergency physicians (22).…”

Section: Discussionmentioning

confidence: 99%

The Role of Emergency Physicians on the Management of Chest Pain

Başol¹,

Çığşar²,

Atalay³

et al. 2015

J Contemp Med

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Giriş ve Amaç: Göğüs ağrısı, acil serviste yaygın ve önemli bir başvuru şikayetidir. Özellikle akut koroner sendromu (AKS) içeren ayırıcı tanı acil servis hekimleri tarafından dikkatlice yapılmalıdır. Sunulan bu calışma acil servise göğüs ağrısı şikayeti ile gelen hastaların AKS olup olmamalarına göre incelenmesini amaçlamaktadır. Materyal-Metod: Çalışma, ileriye dönük olarak bir yıllık süreçte göğüs ağrısı şikayeti ile bir üniversite acil servisine başvuran hastalar ile yapıldı. Hastaların yaş, cinsiyet, özgeçmiş, acil servise geliş şekli, elektrokardiyografi (EKG) çekilme zamanı, ana tanısı, konsultasyon durumu, son durumu ve acil serviste kalış süreleri kayıt edildi. Veriler SPSS 17.0 programı ile analiz edildi. Bulgular: Acil servise göğüs ağrısı ile başvuran 325 hasta çalışmaya dahil edildi. Bu hastaların %24.3'ü AKS tanısı aldı. Hastaların çoğunun (%42.5) ambulans ile acil servise geldiği, 110 (%33.8) hastanın kardiyolojiye konsulte edildiği saptandı. İleri yaş AKS ile istatistiksel olarak anlamlı düzeyde ilişkili bulundu (p<0.001). Bunun yanında, sıkıstırici, baskı tarzında ve yanıcı tip göğüs ağrıları da AKS ile ilişkili saptandı (p<0.040). Acil serviste kalış süresi AKS olan hastalarda olmayanlara göre daha kısaydı (p<0.001). Sonuç: Bu çalışma, acil servise göğüs ağrısı ile başvuran hastaların yönetiminde acil servis hekimlerinin rolüne dikkat çekmektedir. Erken ve doğru tani özellikle AKS yönetiminde çok önemli ve elzemdir.

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Comparative care and outcomes for acute coronary syndromes in Central and Eastern European Transitional countries: A review of the literature

Cited by 24 publications

References 45 publications

Prehospital diagnosis of patients with acute myocardial infarction

Prehospital diagnosis of patients with acute myocardial infarction

Patient and hospital determinants of primary percutaneous coronary intervention in England, 2003–2013

The Role of Emergency Physicians on the Management of Chest Pain

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