Hélder Pereira1, Fausto J Pinto2, Rita Calé3, Ernesto Pereira3, Sofia Mello4, Sílvia Vitorino3, Pedro Jerónimo de Sousa5, Bruno Brochado6, Sílvia Monteiro7, Rui Campante Teles8. 1. Cardiology Department, Hospital Garcia de Orta, Almada, Portugal. Electronic address: hhpereira@gmail.com. 2. Cardiology Department, CCUL, CAML, University of Lisbon, Lisbon, Portugal. 3. Cardiology Department, Hospital Garcia de Orta, Almada, Portugal. 4. SFL Project Manager, Lisbon, Portugal. 5. Cardiology Department, Hospital Garcia de Orta, Almada, Portugal; Cardiology Department, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal. 6. Cardiology Department, Centro Hospitalar do Porto, Porto, Portugal. 7. Cardiology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal. 8. Cardiology Department, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal.
Abstract
INTRODUCTION AND AIMS: System delay (time between first medical contact and reperfusion therapy) is an indicator of quality of primary percutaneous coronary intervention (pPCI) in ST-segment elevation myocardial infarction (STEMI) patients. This study aimed to assess changes in system delay between 2011 and 2015, and to identify its predictors. METHODS: The study included 838 patients admitted to 18 Portuguese interventional cardiology centers suspected of having STEMI with less than 12 hours' duration who were referred for primary percutaneous coronary intervention. Data were collected for a one-month period every year from 2011 to 2015. Univariate and multivariate logistic regression models were used to determine predictors of system delay. RESULTS: No significant changes in system delay were observed during the study. Only 27% of patients had a system delay of ≤90 min. Multivariate analysis identified four predictors of system delay: age ≥75 years (OR 2.57; 95% CI 1.50-4.59; p=0.001), attending a center without pPCI (OR 4.08; 95% CI 2.75-6.10; p<0.001), not calling the national medical emergency number (112) (OR 0.47; 95% CI 0.32-0.68; p<0.001), and Central region (OR 3.43; 95% CI 1.60-8.31; p=0.003). CONCLUSIONS: The factors age ≥75 years, attending a center without pPCI, not calling 112, and Central region were identified as predicting longer system delay. This knowledge may help in planning interventions to reduce system delay and to improve the clinical outcomes of patients with STEMI.
INTRODUCTION AND AIMS: System delay (time between first medical contact and reperfusion therapy) is an indicator of quality of primary percutaneous coronary intervention (pPCI) in ST-segment elevation myocardial infarction (STEMI) patients. This study aimed to assess changes in system delay between 2011 and 2015, and to identify its predictors. METHODS: The study included 838 patients admitted to 18 Portuguese interventional cardiology centers suspected of having STEMI with less than 12 hours' duration who were referred for primary percutaneous coronary intervention. Data were collected for a one-month period every year from 2011 to 2015. Univariate and multivariate logistic regression models were used to determine predictors of system delay. RESULTS: No significant changes in system delay were observed during the study. Only 27% of patients had a system delay of ≤90 min. Multivariate analysis identified four predictors of system delay: age ≥75 years (OR 2.57; 95% CI 1.50-4.59; p=0.001), attending a center without pPCI (OR 4.08; 95% CI 2.75-6.10; p<0.001), not calling the national medical emergency number (112) (OR 0.47; 95% CI 0.32-0.68; p<0.001), and Central region (OR 3.43; 95% CI 1.60-8.31; p=0.003). CONCLUSIONS: The factors age ≥75 years, attending a center without pPCI, not calling 112, and Central region were identified as predicting longer system delay. This knowledge may help in planning interventions to reduce system delay and to improve the clinical outcomes of patients with STEMI.
Keywords:
Atraso do sistema; Enfarte do miocárdio com supradesnivelamento do segmento ST; Fatores preditivos; Predictive factors; ST-segment elevation myocardial infarction; Stent for Life; System delay
Authors: João André Ferreira; Rui Miguel Baptista; Sílvia Reis Monteiro; Lino Manuel Gonçalves Journal: Medicine (Baltimore) Date: 2021-01-22 Impact factor: 1.889