Mustafa Kemal Erol1, Meral Kayıkçıoğlu2, Mustafa Kılıçkap3, Arda Güler4, Önder Öztürk5, Burcu Tuncay6, Sinan İnci7, İsmail Balaban8, Fatih Tatar9, Ömer Faruk Çırakoğlu10, Emine Gazi11, Eftal Murat Bakırcı12, Çağrı Yayla13, Mehmet Ali Astarcıoğlu14, Bilge Duran Karaduman15, Ekrem Aksu16, Yakup Alsancak17, Nadir Emlek18, Mustafa Kürşat Tigen19, Nihan Turhan Cağlar20, Ramazan Düz21, Mehmet Inanir22, Öner Özdoğan23, Oğuz Yavuzgil2. 1. Department Of Cardiology, Şişli International Kolan Hospital; Istanbul-Turkey. 2. Department of Cardiology, Faculty of Medicine, Ege University; İzmir-Turkey. 3. Department of Cardiology, Faculty of Medicine, Ankara University; Ankara-Turkey. 4. Department of Cardiology, Health Science University, İstanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital; İstanbul-Turkey. 5. Department of Cardiology, Health Science University, Gazi Yaşargil Training and Research Hospital; Diyarbakır-Turkey. 6. Department of Cardiology, Health Science University, Bursa Yüksek İhtisas Training and Research Hospital; Bursa-Turkey. 7. Department of Cardiology, Faculty of Medicine, Aksaray University; Aksaray-Turkey. 8. Department of Cardiology, Health Science University, Kartal Koşuyolu Yüksek İhtisas Training and Research Hospital; İstanbul-Turkey. 9. Department of Cardiology, Faculty of Medicine, Bülent Ecevit University; Zonguldak-Turkey. 10. Department of Cardiology, Health Science University, Ahi Evran Thoracic and Cardiovascular Surgery Training and Research Hospital; Trabzon-Turkey. 11. Department of Cardiology, Faculty of Medicine, Onsekiz Mart University; Çanakkale-Turkey. 12. Department of Cardiology, Faculty of Medicine, Erzincan Binali Yıldırım University; Erzincan-Turkey. 13. Department of Cardiology, Health Science University, Türkiye Yüksek İhtisas Training and Research Hospital; Ankara-Turkey. 14. Department of Cardiology, Yıldırım Beyazıt University, Atatürk Training and Research Hospital; Ankara-Turkey. 15. Department of Cardiology, Dumlupınar University, Evliya Çelebi Training and Research Hospital; Kütahya-Turkey. 16. Department of Cardiology, Faculty of Medicine, Sütçü İmam University; Kahramanmaras-Turkey. 17. Department of Cardiology, Faculty of Medicine, Necmettin Erbakan University; Konya-Turkey. 18. Department of Cardiology, Faculty of Medicine, Recep Tayyip Erdoğan University; Rize-Turkey. 19. Department of Cardiology, Faculty of Medicine, Marmara University; İstanbul-Turke. 20. Department of Cardiology, Health Science University, Bakırköy Dr. Sadi Konuk Training and Research Hospital; İstanbul-Turkey. 21. Department of Cardiology, Health Science University, Van Training and Research Hospital; Van-Turkey. 22. Department of Cardiology, Faculty of Medicine, Abant İzzet Baysal University; Bolu-Turkey. 23. Department of Cardiology, Health Science University, Tepecik Training and Research Hospital; İzmir-Turkey.
Abstract
OBJECTIVE: In this study, we aimed to analyze the TURKMI registry to identify the factors associated with delays from symptom onset to treatment that would be the focus of improvement efforts in patients with acute myocardial infarction (AMI) in Turkey. METHODS: The TURKMI study is a nation-wide registry that was conducted in 50 centers capable of 24/7 primary percutaneous coronary intervention (PCI). All consecutive patients (n=1930) with AMI admitted to coronary care units within 48 hours of symptom onset were prospectively enrolled during a predefined 2-week period between November 1, 2018, and November 16, 2018. All the patients were examined in detail with regard to the time elapsed at each step from symptom onset to initiation of treatment, including door-to-balloon time (D2B) and total ischemic time (TIT). RESULTS: After excluding patients who suffered an AMI within the hospital (2.6%), the analysis was conducted for 1879 patients. Most of the patients (49.5%) arrived by self-transport, 11.8% by emergency medical service (EMS) ambulance, and 38.6% were transferred from another EMS without PCI capability. The median time delay from symptom-onset to EMS call was 52.5 (15-180) min and from EMS call to EMS arrival 15 (10-20) min. In ST-segment elevation myocardial infarction (STEMI), the median D2B time was 36.5 (25-63) min, and median TIT was 195 (115-330) min. TIT was significantly prolonged from 151 (90-285) min to 250 (165-372) min in patients transferred from non-PCI centers. The major significant factors associated with time delay were patient-related delay and the mode of hospital arrival, both in STEMI and non-STEMI. CONCLUSION: The baseline evaluation of the TURKMI study revealed that an important proportion of patients presenting with AMI within 48 hours of symptom onset reach the PCI treatment center later than the time proposed in the guidelines, and the use of EMS for admission to hospital is extremely low in Turkey. Patient-related factors and the mode of hospital admission were the major factors associated with the time delay to treatment.
OBJECTIVE: In this study, we aimed to analyze the TURKMI registry to identify the factors associated with delays from symptom onset to treatment that would be the focus of improvement efforts in patients with acute myocardial infarction (AMI) in Turkey. METHODS: The TURKMI study is a nation-wide registry that was conducted in 50 centers capable of 24/7 primary percutaneous coronary intervention (PCI). All consecutive patients (n=1930) with AMI admitted to coronary care units within 48 hours of symptom onset were prospectively enrolled during a predefined 2-week period between November 1, 2018, and November 16, 2018. All the patients were examined in detail with regard to the time elapsed at each step from symptom onset to initiation of treatment, including door-to-balloon time (D2B) and total ischemic time (TIT). RESULTS: After excluding patients who suffered an AMI within the hospital (2.6%), the analysis was conducted for 1879 patients. Most of the patients (49.5%) arrived by self-transport, 11.8% by emergency medical service (EMS) ambulance, and 38.6% were transferred from another EMS without PCI capability. The median time delay from symptom-onset to EMS call was 52.5 (15-180) min and from EMS call to EMS arrival 15 (10-20) min. In ST-segment elevation myocardial infarction (STEMI), the median D2B time was 36.5 (25-63) min, and median TIT was 195 (115-330) min. TIT was significantly prolonged from 151 (90-285) min to 250 (165-372) min in patients transferred from non-PCI centers. The major significant factors associated with time delay were patient-related delay and the mode of hospital arrival, both in STEMI and non-STEMI. CONCLUSION: The baseline evaluation of the TURKMI study revealed that an important proportion of patients presenting with AMI within 48 hours of symptom onset reach the PCI treatment center later than the time proposed in the guidelines, and the use of EMS for admission to hospital is extremely low in Turkey. Patient-related factors and the mode of hospital admission were the major factors associated with the time delay to treatment.
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