Performance analysis of a STEMI network: prognostic impact of the type of first medical contact facility

Prognosis in ST-elevation myocardial infarction (STEMI) is determined by delay in primary percutaneous coronary intervention (PPCI). The impact of first medical contact (FMC) facility type on reperfusion delays and mortality remains controversial.We performed a prospective registry of primary corona...

Descripción completa

Detalles Bibliográficos
Autores: de Diego, Oriol, Rueda Sobella, Ferran, Carrillo, Xavier, Oliveras, Teresa, Andrea, Rut, Ouaddi, Nabil El, Serra, Jordi, Labata, Carlos, Ferrer, Marc, Martínez Membrive, María J., Montero, Santiago, Mauri, Josepa, García Picart, Joan, Rojas, Sergio, Ariza, Albert, Tizon Marcos, Helena, Faiges, Marta, Cárdenas, Mérida, Lidón, Rosa María, Muñoz Camacho, Juan F., Jiménez Fàbrega, Xavier, Lupón, Josep, Bayes Genis, Antoni, García García, Cosme, Codi Infart Registry Investigators
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2023
País:España
Institución:Universidad de Barcelona
Repositorio:Dipòsit Digital de la UB
OAI Identifier:oai:diposit.ub.edu:2445/208346
Acceso en línea:https://hdl.handle.net/2445/208346
Access Level:acceso abierto
Palabra clave:Serveis d'urgències mèdiques
Pronòstic mèdic
Emergency Medical Services
Prognosis
Descripción
Sumario:Prognosis in ST-elevation myocardial infarction (STEMI) is determined by delay in primary percutaneous coronary intervention (PPCI). The impact of first medical contact (FMC) facility type on reperfusion delays and mortality remains controversial.We performed a prospective registry of primary coronary intervention (PCI)-treated STEMI patients (2010-2020) in the Codi Infart STEMI network. We analyzed 1-year all-cause mortality depending on the FMC facility type: emergency medical service (EMS), community hospital (CH), PCI hospital (PCI-H), or primary care center (PCC).We included 18?332 patients (EMS 34.3%; CH 33.5%; PCI-H 12.3%; PCC 20.0%). Patients with Killip-Kimball classes III-IV were: EMS 8.43%, CH 5.54%, PCI-H 7.51%, PCC 3.76% (P?<?.001). All comorbidities and first medical assistance complications were more frequent in the EMS and PCI-H groups (P?<?.05) and were less frequent in the PCC group (P?<?.05 for most variables). The PCI-H group had the shortest FMC-to-PCI delay (median 82?minutes); the EMS group achieved the shortest total ischemic time (median 151?minutes); CH had the longest reperfusion delays (P?<?.001). In an adjusted logistic regression model, the PCI-H and CH groups were associated with higher 1-year mortality, OR, 1.22 (95%CI, 1.00-1.48; P?=?.048), and OR, 1.17 (95%CI 1.02-1.36; P?=?.030), respectively, while the PCC group was associated with lower 1-year mortality than the EMS group, OR,?0.71 (95%CI 0.58-0.86; P?<?.001).FMC with PCI-H and CH was associated with higher adjusted 1-year mortality than FMC with EMS. The PCC group had a much lower intrinsic risk and was associated with better outcomes despite longer revascularization delays.Copyright © 2023 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

Similares en LA Referencia