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Ribera A, Marsal JR, Faixedas MT, Rosas A, Tizón-Marcos H, Rojas S, Labata C, Cárdenas M, Homs S, Tomás-Querol C, García-Picart J, Roura G, Masotti M, Mauri J, Pijoan JI, Barrabés JA, Ferreira-González I. Revascularized ST-segment elevation myocardial infarction. Temporal trends in contemporary therapies and impact on outcomes. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2022; 75:659-668. [PMID: 34887210 DOI: 10.1016/j.rec.2021.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 10/19/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION AND OBJECTIVES To assess, in patients with ST-segment elevation myocardial infarction (STEMI) who underwent primary percutaneous intervention, the pace of introduction in clinical practice (2010-2017) of drug-eluting stents (DES), ticagrelor, prasugrel, and prolonged dual antiplatelet therapy (DAPT) duration, and their potential impact on the risk of 2-year outcomes. METHODS Prospective and exhaustive community-wide cohort of 14 841 STEMI patients undergoing primary percutaneous intervention between 2010 and 2017. Index episodes were obtained from the Catalan Codi IAM Registry, events during follow-up from the Minimum Data Set and DAPT were defined by pharmacy dispensation. Follow-up was 24 months. The temporal trend for exposures and outcomes was assessed using regression models. RESULTS Age> 65 years, diabetes, renal failure, previous heart failure, and need for anticoagulation at discharge were more frequent in later periods (P <.001). From 2010 to 2017, the use of DES increased from 31.1% to 69.8%, ticagrelor from 0.1% to 28.6%, prasugrel from 1.5% to 23.8%, and the median consecutive months on DAPT from 2 to 10 (P <.001 for all). Adjusted analysis showed a temporal trend to a lower risk of the main outcome over time: the composite of death, acute myocardial infarction, stroke and repeat revascularization (absolute odds reduction 0.005% each quarter; OR, 0.995; 95%CI, 0.99-0.999; P=.028). The odds of all individual components except stroke were reduced, although significance was only reached for revascularization. CONCLUSIONS Despite a strong increase between 2010 and 2017 in the use and duration of DAPT and the use of ticagrelor, prasugrel and DES, there was no substantial reduction in major cardiovascular outcomes.
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Affiliation(s)
- Aida Ribera
- Servicio de Cardiología, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Spain.
| | - Josep R Marsal
- Servicio de Cardiología, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Spain
| | | | - Alba Rosas
- Departament de Salut, Generalitat de Catalunya, Barcelona, Spain
| | - Helena Tizón-Marcos
- Servicio de Cardiología, Hospital del Mar, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Spain
| | - Sergio Rojas
- Servicio de Cardiología, Hospital Universitari de Tarragona Joan XXIII, IISPV, Universidad Rovira Virgili, Tarragona, Spain
| | - Carlos Labata
- Servicio de Cardiología, Hospital German Trias i Pujol, Barcelona, Spain
| | - Mérida Cárdenas
- Servicio de Cardiología, Hospital Josep Trueta, Girona, Spain
| | - Silvia Homs
- Servicio de Cardiología, Hospital Mútua de Terrassa, Terrassa, Barcelona, Spain
| | | | - Joan García-Picart
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Gerard Roura
- Servicio de Cardiología, Hospital de Bellvitge, Barcelona, Spain
| | - Mónica Masotti
- Servicio de Cardiología, Hospital Clínic, Barcelona, Spain
| | - Josepa Mauri
- Servicio de Cardiología, Hospital Universitari de Tarragona Joan XXIII, IISPV, Universidad Rovira Virgili, Tarragona, Spain
| | - José Ignacio Pijoan
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Spain; Unidad de Epidemiología Clínica, Hospital Universitario Cruces/Instituto de Investigación BioCruces-Bizkaia, Barakaldo, Bizkaia, Spain
| | - José A Barrabés
- Servicio de Cardiología, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Spain
| | - Ignacio Ferreira-González
- Servicio de Cardiología, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Spain
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Oliveras T, Revuelta-López E, García-García C, Cserkóová A, Rueda F, Labata C, Ferrer M, Montero S, El-Ouaddi N, Martínez MJ, Roura S, Gálvez-Montón C, Bayes-Genis A. Circulating virome and inflammatory proteome in patients with ST-elevation myocardial infarction and primary ventricular fibrillation. Sci Rep 2022; 12:7910. [PMID: 35552514 PMCID: PMC9098642 DOI: 10.1038/s41598-022-12075-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 05/05/2022] [Indexed: 11/09/2022] Open
Abstract
Primary ventricular fibrillation (PVF) is a life-threatening complication of ST-segment elevation myocardial infarction (STEMI). It is unclear what roles viral infection and/or systemic inflammation may play as underlying triggers of PVF, as a second hit in the context of acute ischaemia. Here we aimed to evaluate whether the circulating virome and inflammatory proteome were associated with PVF development in patients with STEMI. Blood samples were obtained from non-PVF and PVF STEMI patients at the time of primary PCI, and from non-STEMI healthy controls. The virome profile was analysed using VirCapSeq-VERT (Virome Capture Sequencing Platform for Vertebrate Viruses), a sequencing platform targeting viral taxa of 342,438 representative sequences, spanning all virus sequence records. The inflammatory proteome was explored with the Olink inflammation panel, using the Proximity Extension Assay technology. After analysing all viral taxa known to infect vertebrates, including humans, we found that non-PVF and PVF patients only significantly differed in the frequencies of viruses in the Gamma-herpesvirinae and Anelloviridae families. In particular, most showed a significantly higher relative frequency in non-PVF STEMI controls. Analysis of systemic inflammation revealed no significant differences between the inflammatory profiles of non-PVF and PVF STEMI patients. Inflammatory proteins associated with cell adhesion, chemotaxis, cellular response to cytokine stimulus, and cell activation proteins involved in immune response (IL6, IL8 CXCL-11, CCL-11, MCP3, MCP4, and ENRAGE) were significantly higher in STEMI patients than non-STEMI controls. CDCP1 and IL18-R1 were significantly higher in PVF patients compared to healthy subjects, but not compared to non-PVF patients. The circulating virome and systemic inflammation were not associated with increased risk of PVF development in acute STEMI. Accordingly, novel strategies are needed to elucidate putative triggers of PVF in the setting of acute ischaemia, in order to reduce STEMI-driven sudden death burden.
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Affiliation(s)
- Teresa Oliveras
- Heart Failure Unit and Cardiology Department, Hospital Universitari Germans Trias i Pujol, Carretera de Canyet s/n, Badalona, 08916, Barcelona, Spain. .,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Elena Revuelta-López
- Heart Failure and Cardiac Regeneration (ICREC) Research Program, Health Sciences Research Institute Germans Trias i Pujol (IGTP), Badalona, Barcelona, Spain.,CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | - Cosme García-García
- Heart Failure Unit and Cardiology Department, Hospital Universitari Germans Trias i Pujol, Carretera de Canyet s/n, Badalona, 08916, Barcelona, Spain.,CIBERCV, Instituto de Salud Carlos III, Madrid, Spain.,Faculty of Medicine, University of Vic-Central University of Catalonia (UVic-UCC), Vic, Barcelona, Spain
| | - Adriana Cserkóová
- Heart Failure and Cardiac Regeneration (ICREC) Research Program, Health Sciences Research Institute Germans Trias i Pujol (IGTP), Badalona, Barcelona, Spain.,CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | - Ferran Rueda
- Heart Failure Unit and Cardiology Department, Hospital Universitari Germans Trias i Pujol, Carretera de Canyet s/n, Badalona, 08916, Barcelona, Spain
| | - Carlos Labata
- Heart Failure Unit and Cardiology Department, Hospital Universitari Germans Trias i Pujol, Carretera de Canyet s/n, Badalona, 08916, Barcelona, Spain
| | - Marc Ferrer
- Heart Failure Unit and Cardiology Department, Hospital Universitari Germans Trias i Pujol, Carretera de Canyet s/n, Badalona, 08916, Barcelona, Spain
| | - Santiago Montero
- Heart Failure Unit and Cardiology Department, Hospital Universitari Germans Trias i Pujol, Carretera de Canyet s/n, Badalona, 08916, Barcelona, Spain
| | - Nabil El-Ouaddi
- Heart Failure Unit and Cardiology Department, Hospital Universitari Germans Trias i Pujol, Carretera de Canyet s/n, Badalona, 08916, Barcelona, Spain
| | - Maria José Martínez
- Heart Failure Unit and Cardiology Department, Hospital Universitari Germans Trias i Pujol, Carretera de Canyet s/n, Badalona, 08916, Barcelona, Spain
| | - Santiago Roura
- Heart Failure and Cardiac Regeneration (ICREC) Research Program, Health Sciences Research Institute Germans Trias i Pujol (IGTP), Badalona, Barcelona, Spain.,CIBERCV, Instituto de Salud Carlos III, Madrid, Spain.,Faculty of Medicine, University of Vic-Central University of Catalonia (UVic-UCC), Vic, Barcelona, Spain
| | - Carolina Gálvez-Montón
- Heart Failure and Cardiac Regeneration (ICREC) Research Program, Health Sciences Research Institute Germans Trias i Pujol (IGTP), Badalona, Barcelona, Spain.,CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | - Antoni Bayes-Genis
- Heart Failure Unit and Cardiology Department, Hospital Universitari Germans Trias i Pujol, Carretera de Canyet s/n, Badalona, 08916, Barcelona, Spain. .,Heart Failure and Cardiac Regeneration (ICREC) Research Program, Health Sciences Research Institute Germans Trias i Pujol (IGTP), Badalona, Barcelona, Spain. .,CIBERCV, Instituto de Salud Carlos III, Madrid, Spain. .,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain. .,Heart Institute, Hospital Universitari Germans Trias i Pujol, Carretera de Canyet s/n, Badalona, 08916, Barcelona, Spain.
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Infarto de miocardio con elevación del segmento ST revascularizado. Tendencias temporales de los tratamientos contemporáneos y su impacto en los resultados. Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2021.10.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Martínez-Sellés M, Juárez M, Marina-Breysse M, Lillo-Castellano JM, Ariza A. Rational and design of ST-segment elevation not associated with acute cardiac necrosis (LESTONNAC). A prospective registry for validation of a deep learning system assisted by artificial intelligence. J Electrocardiol 2021; 69:140-144. [PMID: 34763217 DOI: 10.1016/j.jelectrocard.2021.10.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 10/05/2021] [Accepted: 10/27/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Patients with chest pain and persistent ST segment elevation (STE) may not have acute coronary occlusions or serum troponin curves suggestive of acute necrosis. Our objective is the validation and cost-effectiveness analysis of a diagnostic model assisted by artificial intelligence (AI). METHODS Prospective multicenter registry in two groups of patients with STE: I) coronary arteries without significant lesions and without serum troponin curve suggestive of acute necrosis, II) myocardial infarction with acute coronary occlusion. The inclusion criteria are the following: 1) age ≥ 18 years, 2) chest pain or symptoms suggestive of myocardial ischemia, 3) STE at point J in two contiguous leads ≥0.1 mV, in V2 and V3 ≥ 0,2 mV and 4) signature of informed consent. The exclusion criteria are the following: 1) left bundle branch block, 2) acute cardiac necrosis in the absence of significant epicardial coronary artery stenosis, 3) STE ≤ 0.1 mV with pathologic Q wave, 4) severe anemia (hemoglobin <8.0 g/dl). For each patient without acute cardiac necrosis, the next patient from that center of the same sex and similar age (± 5 years) with myocardial infarction and acute coronary occlusion will be included. A manual centralized electrocardiographic analysis and another by deep learning AI will be performed. CONCLUSIONS The results of the study will provide new information for the stratification of patients with STE. Our hypothesis is that an AI analysis of the surface electrocardiogram allows a better distinction of patients with STE due to acute myocardial ischemia, from those with another etiology.
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Affiliation(s)
- Manuel Martínez-Sellés
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Facultad de Ciencias Biomédicas y de la Salud, Universidad Europea, Madrid, Spain; Facultad de Medicina, Universidad Complutense, Madrid, Spain.
| | - Miriam Juárez
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Manuel Marina-Breysse
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; IDOVEN Research, Madrid, Spain; Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Myocardial Pathophysiology Area, Madrid, Spain
| | - José María Lillo-Castellano
- IDOVEN Research, Madrid, Spain; Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Myocardial Pathophysiology Area, Madrid, Spain
| | - Albert Ariza
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario de Bellvitge -IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
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Mehta S, Aboushi H, Campos C, Botelho R, Fernandez F, Rodriguez D, Torres M, Vieria D, Frauenfelder A, Pinto G, Lopez C, Acosta M. Impact of a telemedicine-guided, population-based, STEMI network on reperfusion strategy, efficiency, and outcomes: Impact of telemedicine on STEMI management. ASIAINTERVENTION 2021; 7:18-26. [PMID: 34912998 PMCID: PMC8657047 DOI: 10.4244/aij-d-18-00047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 05/25/2021] [Indexed: 06/14/2023]
Abstract
AIMS A telemedicine-guided strategy increases the access to and efficiency of ST-elevation myocardial infarction (STEMI) networks resulting in increased access to, and reduced disparities in, acute myocardial infarction (AMI) care between rural and urban areas. METHODS AND RESULTS The Latin America Telemedicine Infarct Network (LATIN) was developed for poor and remote regions in Brazil and Colombia that lacked coordinated AMI systems of care. It strategically connects small clinics and primary care health centres (spokes) to hubs with 24/7 percutaneous coronary intervention (PCI) capability. Experts at three remote sites provide urgent electrocardiogram (ECG) diagnosis and tele-consultation for the entire network. Data from the busiest LATIN site, the Santa Marcelina Hospital in Sao Paolo, Brazil, were compared with health statistics from Sistema Unico de Saude (Brazilian Public Health System - SUS). A total of 192 centres were networked using standardised and guideline-based protocols for AMI care. Overall, 313,897 patients were remotely screened, 3,572 AMI diagnosed (1.1%), and 1,636 AMI urgently reperfused (45.8%), mainly by primary PCI (n=1,351; 83%). CONCLUSIONS In conclusion, a comparison between a pre-LATIN cohort from SUS (1,015) and a LATIN cohort from Santa Marcelina Hospital (1,247) revealed increased reperfusion with PCI (65.52% vs 75.2%), increased cost ($2,037.12 vs $2,246.40, p<0.005), a statistically significant reduction in PCI mortality (8.5% vs 4.3% p<0.01) and a non-significant reduction in mortality overall amongst all treatment pathways (9.69% vs 9.43%, p=0.931).
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Affiliation(s)
| | - Haytham Aboushi
- Lumen Foundation, 185 Shore Dr S, Miami, FL 33133, USA. E-mail:
| | - Carlos Campos
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, and Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Roberto Botelho
- Triangulo Heart Institute and Eurolatino Medical Research, Uberlandia, Brazil
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7
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Guertin JR, Conombo B, Langevin R, Bergeron F, Holbrook A, Humphries B, Matteau A, Potter BJ, Renoux C, Tarride JÉ, Durand M. A Systematic Review of Methods Used for Confounding Adjustment in Observational Economic Evaluations in Cardiology Conducted between 2013 and 2017. Med Decis Making 2020; 40:582-595. [PMID: 32627666 DOI: 10.1177/0272989x20937257] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. Observational economic evaluations (i.e., economic evaluations in which treatment allocation is not randomized) are prone to confounding bias. Prior reviews published in 2013 have shown that adjusting for confounding is poorly done, if done at all. Although these reviews raised awareness on the issues, it is unclear if their results improved the methodological quality of future work. We therefore aimed to investigate whether and how confounding was accounted for in recently published observational economic evaluations in the field of cardiology. Methods. We performed a systematic review of PubMed, Embase, Cochrane Library, Web of Science, and PsycInfo databases using a set of Medical Subject Headings and keywords covering topics in "observational economic evaluations in health within humans" and "cardiovascular diseases." Any study published in either English or French between January 1, 2013, and December 31, 2017, addressing our search criteria was eligible for inclusion in our review. Our protocol was registered with PROSPERO (CRD42018112391). Results. Forty-two (0.6%) out of 7523 unique citations met our inclusion criteria. Fewer than half of the selected studies adjusted for confounding (n = 19 [45.2%]). Of those that adjusted for confounding, propensity score matching (n = 8 [42.1%]) and other matching-based approaches were favored (n = 8 [42.1%]). Our results also highlighted that most authors who adjusted for confounding rarely justified their methodological choices. Conclusion. Our results indicate that adjustment for confounding is often ignored when conducting an observational economic evaluation. Continued knowledge translation efforts aimed at improving researchers' knowledge regarding confounding bias and methods aimed at addressing this issue are required and should be supported by journal editors.
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Affiliation(s)
- Jason R Guertin
- Department of Social and Preventive Medicine, Université Laval, Quebec City, Canada.,Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Quebec City, Canada
| | - Blanchard Conombo
- Department of Social and Preventive Medicine, Université Laval, Quebec City, Canada.,Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Quebec City, Canada
| | | | | | - Anne Holbrook
- Division of Clinical Pharmacology and Toxicology, Department of Medicine, McMaster University, Hamilton, Canada.,Department of Health Evidence and Impact, McMaster University, Hamilton, Canada
| | - Brittany Humphries
- Department of Health Evidence and Impact, McMaster University, Hamilton, Canada
| | - Alexis Matteau
- Department of Medicine, Université de Montréal, Montreal, Canada.,Centre de recherche du Centre Hospitalier de l'Université de Montréal, Montreal, Canada.,Centre Hospitalier de l'Université de Montréal, Montreal, Canada
| | - Brian J Potter
- Department of Medicine, Université de Montréal, Montreal, Canada.,Centre de recherche du Centre Hospitalier de l'Université de Montréal, Montreal, Canada.,Centre Hospitalier de l'Université de Montréal, Montreal, Canada
| | - Christel Renoux
- McGill University, Montreal, Canada.,Programs for Assessment of Technology in Health (PATH), The Research Institute of St. Joe's Hamilton, St. Joseph's Healthcare Hamilton.,McMaster Chair in Health Technology Management, McMaster University, Hamilton, Canada
| | - Jean-Éric Tarride
- Department of Health Evidence and Impact, McMaster University, Hamilton, Canada.,Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Canada.,Department of Economics; McMaster University, Hamilton, Canada.,Programs for Assessment of Technology in Health (PATH), The Research Institute of St. Joe's Hamilton, St. Joseph's Healthcare Hamilton.,McMaster Chair in Health Technology Management, McMaster University, Hamilton, Canada
| | - Madeleine Durand
- Department of Medicine, Université de Montréal, Montreal, Canada.,Centre de recherche du Centre Hospitalier de l'Université de Montréal, Montreal, Canada.,Centre Hospitalier de l'Université de Montréal, Montreal, Canada
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Economic and Societal Impact of a Systems-of-Care Approach for STEMI Management in Low and Middle-Income Countries: Insights from the TN STEMI Program. Ann Glob Health 2019; 85:122. [PMID: 31673509 PMCID: PMC6798779 DOI: 10.5334/aogh.2508] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The TN STEMI Program was a multicenter, prospective, observational study conducted in Tamil Nadu, India, that assessed the effects of implementing the STEMI India Model for the management of STEMI. We discuss the economic and societal impact in this article. Given that the intervention resulted in an absolute mortality reduction of 3.4%, we calculated a number needed to treat of 30 patients. At an annualized project cost of INR 15.11 million, this approximately calculates to INR 193,749 (USD 3,311) per life saved. The utility of the TN-STEMI Program can be estimated to be 1,108 life-years. This calculates to approximately INR 13,643 (USD 233) per life-year saved. Our estimates will likely be of particular interest to policy makers in low and middle-income countries, where financial and resource constraints pose a perennial public health challenge.
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9
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Wein B, Bashkireva A, Au-Yeung A, Yoculan A, Vinereanu D, Deleanu D, Pereira H, Pereira E, de Mello S, Rumoroso JR, Ganyukov V, Wijns W, Naber CK. Systematic investment in the delivery of guideline-coherent therapy reduces mortality and overall costs in patients with ST-elevation myocardial infarction: Results from the Stent for Life economic model for Romania, Portugal, Basque Country and Kemerovo region. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2019; 9:902-910. [PMID: 31557050 PMCID: PMC7734245 DOI: 10.1177/2048872619853959] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIMS The Stent for Life initiative aims at the reduction of mortality in patients with ST-elevation myocardial infarction by enhancing timely access to primary percutaneous coronary intervention. To assess the associated health and socioeconomic impact, the Stent for Life economic project was launched and applied to four model regions: Romania, Portugal, the Basque Country in Spain, and the Kemerovo region in the Russian Federation. METHODS AND RESULTS The Stent for Life economic model is based on a decision tree that incorporates primary percutaneous coronary intervention rates and mortality. Healthcare costs and indirect costs caused by loss of productivity were estimated. A baseline scenario simulating the status quo was compared to the Stent for Life scenario which integrated changes initiated by the Stent for Life programme. In the four model regions, primary percutaneous coronary intervention numbers rose substantially between 29-303%, while ST-elevation myocardial infarction mortality was reduced between 3-10%. Healthcare costs increased by 8% to 70%. Indirect cost savings ranged from 2-7%. Net societal costs were reduced in all model regions by 2-4%. CONCLUSION The joint effort of the Stent for Life initiative and their local partners successfully saves lives. Moreover, the increase in healthcare costs was outweighed by indirect cost savings, leading to a net cost reduction in all four model regions. These findings demonstrate that systematic investments to improve the access of ST-elevation myocardial infarction patients to guideline-coherent therapy is beneficial, not only for the individual, but also for the society at large.
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Affiliation(s)
- Bastian Wein
- Heart and Vascular Center Oberallgaeu-Kempten, Germany (Member of the SANA Hospital Network) and Contilia Heart and Vascular Center, Elisabeth-Hospital Essen, Germany
| | - Anna Bashkireva
- Siberian Association for Interventional Cardiologists, Russian Federation
| | - Alex Au-Yeung
- Department of Health Economics, Policy & Payments, Medtronic Inc., Santa Rosa, USA, Medtronic Inc., USA
| | | | - Dragos Vinereanu
- Carol Davila University of Medicine and Pharmacy, University and Emergency Hospital Bucharest, Romania
| | - Dan Deleanu
- Department of Invasive Cardiology, Emergency Institute for Cardiovascular Diseases 'Prof. C. C. Iliescu' Bucharest, Romania
| | - Helder Pereira
- Department of Cardiology, Hospital Garcia de Orta, Almada, Portugal
| | - Ernesto Pereira
- Department of Interventional Cardiology, Hospital Garcia de Orta, Almada, Portugal
| | - Sofia de Mello
- Universidade NOVA de Lisboa, Escola Nacional de Saúde Pública/NOVA National of Public Health (ENSP/NNSPH), Lisboa, Portugal
| | - Jose R Rumoroso
- Servicio de Hemidinamica y Cardiolgia Intervencionista, Hospital Quironsalud Bizkaia, Spain
| | - Vladimir Ganyukov
- Scientific Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russia
| | - William Wijns
- The Lambe Institute for Translational Medicine and Curam, National University of Ireland Galway, Ireland
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Ribera A, Ferreira-Gonzalez I, Marsal JR, Oristrell G, Faixedas MT, Rosas A, Tizón-Marcos H, Rojas S, Labata C, Cardenas M, Homs S, Tomas-Querol C, Garcia-Picart J, Gomez-Hospital JA, Pijoan JI, Masotti M, Mauri J, Garcia Dorado D. Persistence with dual antiplatelet therapy after percutaneous coronary intervention for ST-segment elevation acute coronary syndrome: a population-based cohort study in Catalonia (Spain). BMJ Open 2019; 9:e028114. [PMID: 31340964 PMCID: PMC6661631 DOI: 10.1136/bmjopen-2018-028114] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVES Guidelines recommending 12-month dual antiplatelet therapy (DAPT) in patients with ST-elevation acute coronary syndrome (STEACS) undergoing percutaneous coronary intervention (PCI) were published in year 2012. We aimed to describe the influence of guideline implementation on the trend in 12-month persistence with DAPT between 2010 and 2015 and to evaluate its relationship with DAPT duration regimens recommended at discharge from PCI hospitals. DESIGN Observational study based on region-wide registry data linked to pharmacy billing data for DAPT follow-up. SETTING All PCI hospitals (10) belonging to the acute myocardial infarction (AMI) code network in Catalonia (Spain). PARTICIPANTS 10 711 STEACS patients undergoing PCI between 2010 and 2015 were followed up. PRIMARY AND SECONDARY OUTCOME MEASURES Primary outcome was 12-month persistence with DAPT. Calendar year quarter, publication of guidelines, DAPT duration regimen recommended in the hospital discharge report, baseline patient characteristics and significant interactions were included in mixed-effects logistic regression based interrupted time-series models. RESULTS The proportion of patients on-DAPT at 12 months increased from 58% (56-60) in 2010 to 73% (71-75) in 2015. The rate of 12-month persistence with DAPT significantly increased after the publication of clinical guidelines with a time lag of 1 year (OR=1.20; 95% CI 1.11 to 1.30). A higher risk profile, more extensive and complex coronary disease, use of drug-eluting stents (OR=1.90; 95% CI 1.50 to 2.40) and a 12-month DAPT regimen recommendation at discharge from the PCI hospital (OR=5.76; 95% CI 3.26 to 10.2) were associated with 12-month persistence. CONCLUSION Persistence with 12-month DAPT has increased since publication of clinical guidelines. Even though most patients were discharged on DAPT, only 73% with potential indication were on-DAPT 12 months after PCI. A guideline-based recommendation at PCI hospital discharge was highly associated with full persistence with DAPT. Establishing evidence-based, common prescribing criteria across hospitals in the AMI-network would favour adherence and reduce variability.
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Affiliation(s)
- Aida Ribera
- Cardiology Department, Vall d’Hebron University Hospital and Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública CIBERESP, The Spanish Health Institute (ISCIII), Spain
| | - Ignacio Ferreira-Gonzalez
- Cardiology Department, Vall d’Hebron University Hospital and Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública CIBERESP, The Spanish Health Institute (ISCIII), Spain
| | - Josep Ramon Marsal
- Cardiology Department, Vall d’Hebron University Hospital and Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública CIBERESP, The Spanish Health Institute (ISCIII), Spain
| | - Gerard Oristrell
- Cardiology Department, Vall d’Hebron University Hospital and Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red para Enfermedades Cardiovasculares CIBERCV, Spanish Health Institute (ISCIII), Spain
| | | | - Alba Rosas
- Departament de Salut, Generalitat de Catalunya, Barcelona, Spain
| | - Helena Tizón-Marcos
- Cardiology Department, Hospital del Mar, and Heart Diseases Biomedical Research Group and IMIM (Hospital del Mar Medical Research Institute), Faculty of Medicine, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Sergio Rojas
- Cardiology Department, Hospital Universitari de Tarragona Joan XXIII, IISPV, Universidad Rovira Virgili, Tarragona, Spain
| | - Carlos Labata
- Cardiology Department, Hospital Germans Trias i Pujol, Badalona, Spain
| | | | - Silvia Homs
- Cardiology Department, Hospital Mútua de Terrassa, Barcelona, Spain
| | | | - Joan Garcia-Picart
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Jose Ignacio Pijoan
- Clinical Epidemiology Unit, Hospital Universitario de Cruces. Biocruces Bizkaia Health Research Institute, Bilbao, Spain
- Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública CIBERESP, The Spanish Health Institute (ISCIII), Spain
| | - Monica Masotti
- Institut Clínic Cardio vascular (ICCV), Hospital Clínic de Barcelona, Barcelona, Spain
| | - Josepa Mauri
- Departament de Salut, Generalitat de Catalunya, Barcelona, Spain
- Cardiology Department, Hospital Germans Trias i Pujol, Badalona, Spain
| | - David Garcia Dorado
- Cardiology Department, Vall d’Hebron University Hospital and Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red para Enfermedades Cardiovasculares CIBERCV, Spanish Health Institute (ISCIII), Spain
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Yeung J, Matsuyama T, Bray J, Reynolds J, Skrifvars MB. Does care at a cardiac arrest centre improve outcome after out-of-hospital cardiac arrest? - A systematic review. Resuscitation 2019; 137:102-115. [PMID: 30779976 DOI: 10.1016/j.resuscitation.2019.02.006] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 02/08/2019] [Accepted: 02/11/2019] [Indexed: 02/07/2023]
Abstract
AIM To perform a systematic review to answer 'In adults with attempted resuscitation after non-traumatic cardiac arrest does care at a specialised cardiac arrest centre (CAC) compared to care in a healthcare facility not designated as a specialised cardiac arrest centre improve patient outcomes?' METHODS The PRISMA guidelines were followed. We searched bibliographic databases (Embase, MEDLINE and the Cochrane Library (CENTRAL)) from inception to 1st August 2018. Randomised controlled trials (RCTs) and non-randomised studies were eligible for inclusion. Two reviewers independently scrutinized studies for relevance, extracted data and assessed quality of studies. Risk of bias of studies and quality of evidence were assessed using ROBINS-I tool and GRADEpro respectively. Primary outcomes were survival to 30 days with favourable neurological outcomes and survival to hospital discharge with favourable neurological outcomes. Secondary outcomes were survival to 30 days, survival to hospital discharge and return of spontaneous circulation (ROSC) post-hospital arrival for patients with ongoing resuscitation. This systematic review was registered in PROSPERO (CRD 42018093369) RESULTS: We included data from 17 observational studies on out-of-hospital cardiac arrest (OHCA) patients in meta-analyses. Overall, the certainty of evidence was very low. Pooling data from only adjusted analyses, care at CAC was not associated with increased likelihood of survival to 30 days with favourable neurological outcome (OR 2.92, 95% CI 0.68-12.48) and survival to 30 days (OR 2.14, 95% CI 0.73-6.29) compared to care at other hospitals. Whereas patients cared for at CACs had improved survival to hospital discharge with favourable neurological outcomes (OR 2.22, 95% CI 1.74-2.84) and survival to hospital discharge (OR 1.85, 95% CI 1.46-2.34). CONCLUSIONS Very low certainty of evidence suggests that post-cardiac arrest care at CACs is associated with improved outcomes at hospital discharge. There remains a need for high quality data to fully elucidate the impact of CACs.
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Affiliation(s)
- J Yeung
- Warwick Medical School, University of Warwick, United Kingdom.
| | - T Matsuyama
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - J Bray
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne Australia
| | - J Reynolds
- Department of Emergency Medicine, Michigan State University, Grand Rapids, Michigan, USA
| | - M B Skrifvars
- Department of Emergency Care and Services, University of Helsinki and Helsinki University Hospital, Finland
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Melero-Alegria JI, Cascon M, Romero A, Vara PP, Barreiro-Perez M, Vicente-Palacios V, Perez-Escanilla F, Hernandez-Hernandez J, Garde B, Cascon S, Martin-Garcia A, Diaz-Pelaez E, de Dios JM, Uribarri A, Jimenez-Candil J, Cruz-Gonzalez I, Blazquez B, Hernandez JM, Sanchez-Pablo C, Santolino I, Ledesma MC, Muriel P, Dorado-Diaz PI, Sanchez PL. SALMANTICOR study. Rationale and design of a population-based study to identify structural heart disease abnormalities: a spatial and machine learning analysis. BMJ Open 2019; 9:e024605. [PMID: 30765403 PMCID: PMC6398793 DOI: 10.1136/bmjopen-2018-024605] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION This study aims to obtain data on the prevalence and incidence of structural heart disease in a population setting and, to analyse and present those data on the application of spatial and machine learning methods that, although known to geography and statistics, need to become used for healthcare research and for political commitment to obtain resources and support effective public health programme implementation. METHODS AND ANALYSIS We will perform a cross-sectional survey of randomly selected residents of Salamanca (Spain). 2400 individuals stratified by age and sex and by place of residence (rural and urban) will be studied. The variables to analyse will be obtained from the clinical history, different surveys including social status, Mediterranean diet, functional capacity, ECG, echocardiogram, VASERA and biochemical as well as genetic analysis. ETHICS AND DISSEMINATION The study has been approved by the ethical committee of the healthcare community. All study participants will sign an informed consent for participation in the study. The results of this study will allow the understanding of the relationship between the different influencing factors and their relative importance weights in the development of structural heart disease. For the first time, a detailed cardiovascular map showing the spatial distribution and a predictive machine learning system of different structural heart diseases and associated risk factors will be created and will be used as a regional policy to establish effective public health programmes to fight heart disease. At least 10 publications in the first-quartile scientific journals are planned. TRIAL REGISTRATION NUMBER NCT03429452.
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Affiliation(s)
- Jose Ignacio Melero-Alegria
- Department of Cardiology, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Facultad de Medicina, Universidad de Salamanca, and CIBERCV, Salamanca, Spain
| | - Manuel Cascon
- Department of Cardiology, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Facultad de Medicina, Universidad de Salamanca, and CIBERCV, Salamanca, Spain
| | | | - Pedro Pablo Vara
- Department of Cardiology, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Facultad de Medicina, Universidad de Salamanca, and CIBERCV, Salamanca, Spain
| | - Manuel Barreiro-Perez
- Department of Cardiology, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Facultad de Medicina, Universidad de Salamanca, and CIBERCV, Salamanca, Spain
| | - Victor Vicente-Palacios
- Department of Cardiology, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Facultad de Medicina, Universidad de Salamanca, and CIBERCV, Salamanca, Spain
| | | | - Jesus Hernandez-Hernandez
- Department of Cardiology, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Facultad de Medicina, Universidad de Salamanca, and CIBERCV, Salamanca, Spain
| | - Beatriz Garde
- Department of Cardiology, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Facultad de Medicina, Universidad de Salamanca, and CIBERCV, Salamanca, Spain
| | - Sara Cascon
- Robleda Primary Care Center, Salamanca, Spain
| | - Ana Martin-Garcia
- Department of Cardiology, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Facultad de Medicina, Universidad de Salamanca, and CIBERCV, Salamanca, Spain
| | - Elena Diaz-Pelaez
- Department of Cardiology, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Facultad de Medicina, Universidad de Salamanca, and CIBERCV, Salamanca, Spain
| | | | - Aitor Uribarri
- Department of Cardiology, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Facultad de Medicina, Universidad de Salamanca, and CIBERCV, Salamanca, Spain
| | - Javier Jimenez-Candil
- Department of Cardiology, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Facultad de Medicina, Universidad de Salamanca, and CIBERCV, Salamanca, Spain
| | - Ignacio Cruz-Gonzalez
- Department of Cardiology, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Facultad de Medicina, Universidad de Salamanca, and CIBERCV, Salamanca, Spain
| | | | | | - Clara Sanchez-Pablo
- Department of Cardiology, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Facultad de Medicina, Universidad de Salamanca, and CIBERCV, Salamanca, Spain
| | | | | | - Paz Muriel
- Miguel Armijo Primary Care Centre, Salamanca, Spain
| | - P Ignacio Dorado-Diaz
- Department of Cardiology, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Facultad de Medicina, Universidad de Salamanca, and CIBERCV, Salamanca, Spain
| | - Pedro L Sanchez
- Department of Cardiology, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Facultad de Medicina, Universidad de Salamanca, and CIBERCV, Salamanca, Spain
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Kasaie P, Radford M, Kapoor S, Jung Y, Hernandez Novoa B, Dowdy D, Shah M. Economic and epidemiologic impact of guidelines for early ART initiation irrespective of CD4 count in Spain. PLoS One 2018; 13:e0206755. [PMID: 30395635 PMCID: PMC6218062 DOI: 10.1371/journal.pone.0206755] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 10/18/2018] [Indexed: 01/25/2023] Open
Abstract
INTRODUCTION Emerging data suggest that early antiretroviral therapy (ART) could reduce serious AIDS and non-AIDS events and deaths but could also increase costs. In January 2016, the Spanish guidelines were updated to recommend ART at any CD4 count. However, the epidemiologic and economic impacts of early ART initiation in Spain remain unclear. METHODS The Johns Hopkins HIV Economic-Epidemiologic Mathematical Model (JHEEM) was utilized to estimate costs, transmissions, and outcomes in Spain over 20 years. We compared implementation of guidelines for early ART initiation to a counterfactual scenario deferring ART until CD4-counts fall below 350 cells/mm3. We additionally studied the impact of early ART initiation in combination with improvements to HIV screening, care linkage and engagement. RESULTS Early ART initiation (irrespective of CD4-count) is expected to avert 20,100 [95% Uncertainty Range (UR) 11,100-83,000] new HIV cases over the next two decades compared to delayed ART (28% reduction), at an incremental health system cost of €1.05 billion [€0.66 - €1.63] billion, and an incremental cost-effectiveness ratio (ICER) of €29,700 [€13,700 - €41,200] per QALY gained. Projected ICERs declined further over longer time horizon; e.g., an ICER of €12,691 over 30 years. Furthermore, the impact of early ART initiation was potentiated by improved HIV screening among high-risk individuals, averting an estimated 41,600 [23,200-172,200] HIV infections (a 58% decline) compared to delayed ART. CONCLUSIONS Recommendations for ART initiation irrespective of CD4-counts are cost-effective and could avert > 30% of new cases in Spain. Improving HIV diagnosis can amplify this impact.
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Affiliation(s)
- Parastu Kasaie
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | | | - Sunaina Kapoor
- Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
| | - Younghee Jung
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | | | - David Dowdy
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Maunank Shah
- Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
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Mehta S, Vega R, Bojanini F, Corral J, Bulla Á, Botelho R, Fernández F, Rodríguez D, Torres MA, Cortizo Vidal LL. Manejo ejemplar del infarto agudo de miocardio con la utilización de protocolos sofisticados de Telemedicina. REVISTA COLOMBIANA DE CARDIOLOGÍA 2018. [DOI: 10.1016/j.rccar.2018.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Characterization and referral patterns of ST-elevation myocardial infarction patients admitted to chest pain units rather than directly to catherization laboratories. Data from the German Chest Pain Unit Registry. Int J Cardiol 2017; 231:31-35. [PMID: 28189192 DOI: 10.1016/j.ijcard.2016.12.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 11/29/2016] [Accepted: 12/05/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND Direct transfer to the catheterization laboratory for primary percutaneous coronary intervention (PCI) is standard of care for patients with ST-segment elevation myocardial infarction (STEMI). Nevertheless, a significant number of STEMI-patients are initially treated in chest pain units (CPUs) of admitting hospitals. Thus, it is important to characterize these patients and to define why an important deviation from recommended clinical pathways occurs and in particular to quantify the impact of deviation on critical time intervals. METHODS AND RESULTS 1679 STEMI patients admitted to a CPU in the period from 2010 to 2015 were enrolled in the German CPU registry (8.5% of 19,666). 55.9% of the patients were delivered by an emergency medical system (EMS), 16.1% transferred from other hospitals and 15.2% referred by a general practitioner (GP). 12.7% were self-referrals. 55% did not get a pre-hospital ECG. Compared to the EMS, referral by GPs markedly delayed critical time intervals while a pre-hospital ECG demonstrating ST-segment elevation reduced door-to-balloon time. When compared to STEMI patients (n=21,674) enrolled in the ALKK-registry, CPU-STEMI patients had a lower risk profile, their treatment in the CPU was guideline-conform and in-hospital mortality was low (1.5%). CONCLUSIONS CPU-STEMI patients represent a numerically significant group because a pre-hospital ECG was not documented. Treatment in the CPU is guideline-conform and the intra-hospital mortality is low. The lack of a pre-hospital ECG and admission via the GP substantially delay critical time intervals suggesting that in patients with symptoms suggestive an ACS, the EMS should be contacted and not the GP.
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