Christopher B Fordyce1, John A Cairns1, Joel Singer2, Terry Lee2, Julie E Park3, Richard A Vandegriend1, Michele Perry4, Wendy Largy4, Min Gao3, Krishnan Ramanathan5, Graham C Wong6. 1. Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada. 2. School of Population and Public Health and the Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, University of British Columbia, Vancouver, British Columbia, Canada. 3. BC Centre for Improved Cardiovascular Health, Vancouver, British Columbia, Canada. 4. Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada. 5. Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada; Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada. 6. Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada; Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada. Electronic address: gcwong@mail.ubc.ca.
Abstract
BACKGROUND: We describe the evolution of a regional system designed to provide primary percutaneous coronary intervention (pPCI) as the preferred method of revascularization for ST-elevation myocardial infarction (STEMI) and its impact on first medical contact (FMC)-to-device times and in-hospital outcomes. METHODS: Patients with STEMI presenting to the Vancouver Coastal Health Authority between June 2007 and January 2015 (N = 2503) were categorized according to 3 sequential phases: phase 1 = standardization of reperfusion algorithms; phase 2 = use of prehospital electrocardiograms; phase 3 = expedited interfacility transfer for pPCI. In-hospital outcomes by phase and hospital type were analyzed using multivariable logistic regression techniques. RESULTS: Regional pPCI use increased across phases (55.0% vs 72.5% vs 86.7%; P < 0.001) and median FMC-to-device times shortened between phase 1 and later phases at both PCI-capable (117 minutes vs 92 minutes vs 97 minutes, respectively; P < 0.001) and non-PCI-capable hospitals (174 minutes vs 146 minutes vs 123 minutes, respectively; P < 0.001). Overall in-hospital mortality (9.4% vs 8.9% vs 10.3%, respectively; P = 0.54) and congestive heart failure (CHF) (15.8% vs 19.7% vs 22.0%, respectively; P = 0.056) were unchanged across phases. A trend toward increased mortality (9.0% vs 9.3% vs 12.9%, respectively; P = 0.079) and higher rates of CHF (15.7% vs 21.5% vs 25.9%, respectively; P = 0.014) were seen in PCI-capable hospitals. CONCLUSIONS: Our regional STEMI model increased access to pPCI and reduced median reperfusion times. However, FMC-to-device times remained prolonged in many patients and overall clinical outcomes were not improved-in particular at PCI-capable hospitals. A strategy of pPCI as the preferred method of reperfusion may not benefit all patients in a regional model of STEMI care.
BACKGROUND: We describe the evolution of a regional system designed to provide primary percutaneous coronary intervention (pPCI) as the preferred method of revascularization for ST-elevation myocardial infarction (STEMI) and its impact on first medical contact (FMC)-to-device times and in-hospital outcomes. METHODS:Patients with STEMI presenting to the Vancouver Coastal Health Authority between June 2007 and January 2015 (N = 2503) were categorized according to 3 sequential phases: phase 1 = standardization of reperfusion algorithms; phase 2 = use of prehospital electrocardiograms; phase 3 = expedited interfacility transfer for pPCI. In-hospital outcomes by phase and hospital type were analyzed using multivariable logistic regression techniques. RESULTS: Regional pPCI use increased across phases (55.0% vs 72.5% vs 86.7%; P < 0.001) and median FMC-to-device times shortened between phase 1 and later phases at both PCI-capable (117 minutes vs 92 minutes vs 97 minutes, respectively; P < 0.001) and non-PCI-capable hospitals (174 minutes vs 146 minutes vs 123 minutes, respectively; P < 0.001). Overall in-hospital mortality (9.4% vs 8.9% vs 10.3%, respectively; P = 0.54) and congestive heart failure (CHF) (15.8% vs 19.7% vs 22.0%, respectively; P = 0.056) were unchanged across phases. A trend toward increased mortality (9.0% vs 9.3% vs 12.9%, respectively; P = 0.079) and higher rates of CHF (15.7% vs 21.5% vs 25.9%, respectively; P = 0.014) were seen in PCI-capable hospitals. CONCLUSIONS: Our regional STEMI model increased access to pPCI and reduced median reperfusion times. However, FMC-to-device times remained prolonged in many patients and overall clinical outcomes were not improved-in particular at PCI-capable hospitals. A strategy of pPCI as the preferred method of reperfusion may not benefit all patients in a regional model of STEMI care.
Authors: Michael J Thibert; Christopher B Fordyce; John A Cairns; Ricky D Turgeon; Martha Mackay; Terry Lee; Wendy Tocher; Joel Singer; Michele Perry-Arnesen; Graham C Wong Journal: CJC Open Date: 2021-02-16
Authors: Martha H Mackay; Adam Chruscicki; Jim Christenson; John A Cairns; Terry Lee; Ricky Turgeon; John M Tallon; Jennifer Helmer; Joel Singer; Graham C Wong; Christopher B Fordyce Journal: J Am Coll Emerg Physicians Open Date: 2022-06-08
Authors: Renee Y Hsia; Sarah Sabbagh; Nandita Sarkar; Karl Sporer; Ivan C Rokos; John F Brown; Ralph G Brindis; Joanna Guo; Yu-Chu Shen Journal: West J Emerg Med Date: 2017-09-11
Authors: Navraj Malhi; Nima Moghaddam; Farshad Hosseini; Joel Singer; Terry Lee; Ricky D Turgeon; Graham C Wong; Christopher B Fordyce Journal: Can J Cardiol Date: 2022-02-10 Impact factor: 6.614
Authors: Jaihoon Amon; Graham C Wong; Terry Lee; Joel Singer; John Cairns; Jay S Shavadia; Christopher Granger; Kenneth Gin; Tracy Y Wang; Sean van Diepen; Christopher B Fordyce Journal: J Am Heart Assoc Date: 2022-09-03 Impact factor: 6.106
Authors: Joshua B Wenner; Graham C Wong; John A Cairns; Michele Perry-Arnesen; Wendy Tocher; Martha Mackay; Joel Singer; Terry Lee; Christopher B Fordyce Journal: CJC Open Date: 2020-01-30