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Original article

Vol. 150 No. 4546 (2020)

Impact of first medical contact to revascularisation time on long-term clinical outcomes in ST-segment elevation myocardial infarction patients

DOI
https://doi.org/10.4414/smw.2020.20368
Cite this as:
Swiss Med Wkly. 2020;150:w20368
Published
04.11.2020

Summary

INTRODUCTION

We sought to identify predictors for a prolonged delay from first medical contact to revascularisation (FMC-R) in ST-segment elevation myocardial infarction (STEMI) patients at our institution and to assess the impact of a prolonged treatment delay on 3-year clinical outcome.

MTHODS

EVALFAST is a prospective and retrospective registry enrolling all patients admitted directly from pre-hospital care to the catheterisation laboratory at Fribourg Hospital for suspected STEMI, starting in June 2008. Relevant patient and procedural data were collected retrospectively and prospectively. Clinical follow-up was performed by phone or clinic visit. Patients were divided into two groups: FMC-R interval <90 minutes (short) and FMC-R delay of ≥90 minutes (long). The primary clinical endpoint was major adverse cardiac events (MACE) at 3-year follow-up. Secondary clinical endpoints were all-cause death and peak creatine kinase levels. Clinical outcome was compared between the two patient groups (short vs long) using Cox regression analysis.

RESULTS

Of the 406 patients enrolled between 2008 and 2014, 187 (46%) were treated with a short delay and 219 (54%) with a long delay. Age at presentation was the only predictor associated with prolonged delay (per additional year: odds ratio 1.03, 95% confidence interval 1.01–1.05, p = 0.001). The primary clinical endpoint occurred in 15% (n = 28) of patients in the short group, and 25% (n = 54) in the long group (p = 0.02). This difference was driven by higher rates of cardiac death (p = 0.08) and the need for repeat revascularisation (p = 0.11).

CONCLUSION

Increased age impacts the FMC-R delay in patients with STEMI. Patients with shorter treatment delays (<90 minutes after FMC) have significantly lower MACE rates at 3 years.

References

  1. Puymirat E, Simon T, Steg PG, Schiele F, Guéret P, Blanchard D, et al.; USIK USIC 2000 Investigators; FAST MI Investigators. Association of changes in clinical characteristics and management with improvement in survival among patients with ST-elevation myocardial infarction. JAMA. 2012;308(10):998–1006. doi:.https://doi.org/10.1001/2012.jama.11348
  2. Townsend N, Wilson L, Bhatnagar P, Wickramasinghe K, Rayner M, Nichols M. Cardiovascular disease in Europe: epidemiological update 2016. Eur Heart J. 2016;37(42):3232–45. doi:.https://doi.org/10.1093/eurheartj/ehw334
  3. Quinn T, Johnsen S, Gale CP, Snooks H, McLean S, Woollard M, et al.; Myocardial Ischaemia National Audit Project (MINAP) Steering Group. Effects of prehospital 12-lead ECG on processes of care and mortality in acute coronary syndrome: a linked cohort study from the Myocardial Ischaemia National Audit Project. Heart. 2014;100(12):944–50. doi:.https://doi.org/10.1136/heartjnl-2013-304599
  4. Pedersen F, Butrymovich V, Kelbæk H, Wachtell K, Helqvist S, Kastrup J, et al. Short- and long-term cause of death in patients treated with primary PCI for STEMI. J Am Coll Cardiol. 2014;64(20):2101–8. doi:.https://doi.org/10.1016/j.jacc.2014.08.037
  5. McManus DD, Gore J, Yarzebski J, Spencer F, Lessard D, Goldberg RJ. Recent trends in the incidence, treatment, and outcomes of patients with STEMI and NSTEMI. Am J Med. 2011;124(1):40–7. doi:.https://doi.org/10.1016/j.amjmed.2010.07.023
  6. Canto JG, Rogers WJ, Goldberg RJ, Peterson ED, Wenger NK, Vaccarino V, et al.; NRMI Investigators. Association of age and sex with myocardial infarction symptom presentation and in-hospital mortality. JAMA. 2012;307(8):813–22. doi:.https://doi.org/10.1001/jama.2012.199
  7. Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, et al.; ESC Scientific Document Group. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2018;39(2):119–77. doi:.https://doi.org/10.1093/eurheartj/ehx393
  8. Wallentin L, Becker RC, Budaj A, Cannon CP, Emanuelsson H, Held C, et al.; PLATO Investigators. Ticagrelor versus clopidogrel in patients with acute coronary syndromes. N Engl J Med. 2009;361(11):1045–57. doi:.https://doi.org/10.1056/NEJMoa0904327
  9. Wiviott SD, Braunwald E, McCabe CH, Montalescot G, Ruzyllo W, Gottlieb S, et al.; TRITON-TIMI 38 Investigators. Prasugrel versus clopidogrel in patients with acute coronary syndromes. N Engl J Med. 2007;357(20):2001–15. doi:.https://doi.org/10.1056/NEJMoa0706482
  10. Van de Werf F, Bax J, Betriu A, Blomstrom-Lundqvist C, Crea F, Falk V, et al.; ESC Committee for Practice Guidelines (CPG). Management of acute myocardial infarction in patients presenting with persistent ST-segment elevation: the Task Force on the Management of ST-Segment Elevation Acute Myocardial Infarction of the European Society of Cardiology. Eur Heart J. 2008;29(23):2909–45. doi:.https://doi.org/10.1093/eurheartj/ehn416
  11. Carol Ruiz A, Masip Utset J, Ariza Solé A ; researchers of the Codi Infart registry of Catalonia. Predictors of Late Reperfusion in STEMI Patients Undergoing Primary Angioplasty. Impact of the Place of First Medical Contact. Rev Esp Cardiol (Engl Ed). 2017;70(3):162–9. doi:.https://doi.org/10.1016/j.rec.2016.11.030
  12. Gregoratos G. Clinical manifestations of acute myocardial infarction in older patients. Am J Geriatr Cardiol. 2001;10(6):345–7. doi:.https://doi.org/10.1111/j.1076-7460.2001.00641.x
  13. Mehta RH, Rathore SS, Radford MJ, Wang Y, Wang Y, Krumholz HM. Acute myocardial infarction in the elderly: differences by age. J Am Coll Cardiol. 2001;38(3):736–41. doi:.https://doi.org/10.1016/S0735-1097(01)01432-2
  14. Bangalore S, Fonarow GC, Peterson ED, Hellkamp AS, Hernandez AF, Laskey W, et al.; Get with the Guidelines Steering Committee and Investigators. Age and gender differences in quality of care and outcomes for patients with ST-segment elevation myocardial infarction. Am J Med. 2012;125(10):1000–9. doi:.https://doi.org/10.1016/j.amjmed.2011.11.016
  15. Collins SD, Ahmad S, Waksman R. Percutaneous revascularization in women with coronary artery disease: we’ve come so far, yet have so far to go. Nutr Metab Cardiovasc Dis. 2010;20(6):436–44. doi:.https://doi.org/10.1016/j.numecd.2010.02.014
  16. Jneid H, Fonarow GC, Cannon CP, Hernandez AF, Palacios IF, Maree AO, et al.; Get With the Guidelines Steering Committee and Investigators. Sex differences in medical care and early death after acute myocardial infarction. Circulation. 2008;118(25):2803–10. doi:.https://doi.org/10.1161/CIRCULATIONAHA.108.789800
  17. Pagley PR, Yarzebski J, Goldberg R, Chen Z, Chiriboga D, Dalen P, et al. Gender differences in the treatment of patients with acute myocardial infarction. A multihospital, community-based perspective. Arch Intern Med. 1993;153(5):625–9. doi:.https://doi.org/10.1001/archinte.1993.00410050061008
  18. Rezaee ME, Brown JR, Conley SM, Anderson TA, Caron RM, Niles NW. Sex disparities in pre-hospital and hospital treatment of ST-segment elevation myocardial infarction. Hosp Pract (1995). 2013;41(2):25–33. doi:.https://doi.org/10.3810/hp.2013.04.1023
  19. Dauerman HL, Bates ER, Kontos MC, Li S, Garvey JL, Henry TD, et al. Nationwide Analysis of Patients With ST-Segment-Elevation Myocardial Infarction Transferred for Primary Percutaneous Intervention: Findings From the American Heart Association Mission: Lifeline Program. Circ Cardiovasc Interv. 2015;8(5):e002450. doi:.https://doi.org/10.1161/CIRCINTERVENTIONS.114.002450
  20. Tra J, van der Wulp I, de Bruijne MC, Wagner C. Exploring the treatment delay in the care of patients with ST-elevation myocardial infarction undergoing acute percutaneous coronary intervention: a cross-sectional study. BMC Health Serv Res. 2015;15(1):340. doi:.https://doi.org/10.1186/s12913-015-0993-y
  21. Blankenship JC, Skelding KA, Scott TD, Berger PB, Parise H, Brodie BR, et al. Predictors of reperfusion delay in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention from the HORIZONS-AMI trial. Am J Cardiol. 2010;106(11):1527–33. doi:.https://doi.org/10.1016/j.amjcard.2010.07.033
  22. Spencer FA, Montalescot G, Fox KA, Goodman SG, Granger CB, Goldberg RJ, et al.; Global Registry of Acute Coronary Events (GRACE) Investigators. Delay to reperfusion in patients with acute myocardial infarction presenting to acute care hospitals: an international perspective. Eur Heart J. 2010;31(11):1328–36. doi:.https://doi.org/10.1093/eurheartj/ehq057
  23. Hasdai D, Behar S, Wallentin L, Danchin N, Gitt AK, Boersma E, et al.; The Euro Heart Survey of Acute Coronary Syndromes (Euro Heart Survey ACS). A prospective survey of the characteristics, treatments and outcomes of patients with acute coronary syndromes in Europe and the Mediterranean basin; the Euro Heart Survey of Acute Coronary Syndromes (Euro Heart Survey ACS). Eur Heart J. 2002;23(15):1190–201. doi:.https://doi.org/10.1053/euhj.2002.3193
  24. Nielsen PH, Terkelsen CJ, Nielsen TT, Thuesen L, Krusell LR, Thayssen P, et al.; Danami-2 Investigators. System delay and timing of intervention in acute myocardial infarction (from the Danish Acute Myocardial Infarction-2 [DANAMI-2] trial). Am J Cardiol. 2011;108(6):776–81. doi:.https://doi.org/10.1016/j.amjcard.2011.05.007
  25. Rathore SS, Curtis JP, Chen J, Wang Y, Nallamothu BK, Epstein AJ, et al.; National Cardiovascular Data Registry. Association of door-to-balloon time and mortality in patients admitted to hospital with ST elevation myocardial infarction: national cohort study. BMJ. 2009;338(may19 1):b1807. doi:.https://doi.org/10.1136/bmj.b1807
  26. Chakrabarti A, Krumholz HM, Wang Y, Rumsfeld JS, Nallamothu BK ; National Cardiovascular Data Registry. Time-to-reperfusion in patients undergoing interhospital transfer for primary percutaneous coronary intervention in the U.S: an analysis of 2005 and 2006 data from the National Cardiovascular Data Registry. J Am Coll Cardiol. 2008;51(25):2442–3. doi:.https://doi.org/10.1016/j.jacc.2008.02.071
  27. Nallamothu BK, Bates ER, Herrin J, Wang Y, Bradley EH, Krumholz HM ; NRMI Investigators. Times to treatment in transfer patients undergoing primary percutaneous coronary intervention in the United States: National Registry of Myocardial Infarction (NRMI)-3/4 analysis. Circulation. 2005;111(6):761–7. doi:.https://doi.org/10.1161/01.CIR.0000155258.44268.F8
  28. Doost Hosseiny A, Moloi S, Chandrasekhar J, Farshid A. Mortality pattern and cause of death in a long-term follow-up of patients with STEMI treated with primary PCI. Open Heart. 2016;3(1):e000405. doi:.https://doi.org/10.1136/openhrt-2016-000405
  29. Fokkema ML, James SK, Albertsson P, Akerblom A, Calais F, Eriksson P, et al. Population trends in percutaneous coronary intervention: 20-year results from the SCAAR (Swedish Coronary Angiography and Angioplasty Registry). J Am Coll Cardiol. 2013;61(12):1222–30. doi:.https://doi.org/10.1016/j.jacc.2013.01.007
  30. García-García C, Ribas N, Recasens LL, Meroño O, Subirana I, Fernández A, et al. In-hospital prognosis and long-term mortality of STEMI in a reperfusion network. “Head to head” analisys: invasive reperfusion vs optimal medical therapy. BMC Cardiovasc Disord. 2017;17(1):139. doi:.https://doi.org/10.1186/s12872-017-0574-6

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