<abstract xmlns="http://www.w3.org/1999/xhtml">

<sec><h3>Background</h3>
<p>Time intervals related to ST-segment myocardial infarction (STEMI) revascularization are central determinants for patient outcomes. The current capability of the Romanian STEMI program to meet guideline-recommended time intervals is largely unknown.</p>
</sec>
<sec><h3>Aims</h3>
<p>The present study aims to assess the ability of a regional STEMI network to obtain guideline-recommended time intervals for primary percutaneous coronary intervention (pPCI) and to measure the occurrence and the extent of time delays.</p>
</sec>
<sec><h3>Materials and Methods</h3>
<p>This prospective study included 500 consecutive patients with STEMI at the “Prof. Dr. C.C. Iliescu” Emergency Institute for Cardiovascular Diseases, Bucharest, Romania during a period of 14 months. Complete ischemic timelines were created using several key timepoints.</p>
</sec>
<sec><h3>Results</h3>
<p>A secondary route (transfer from another hospital) was noted in most cases. The main time intervals were the following: patient delay 209 min, emergency medical system delay 66 min, and PCI center delay at 70 min, totaling an ischemic time of 6.4 h. A provisional stop at another hospital involved the addition of 113 min (1.8 h) until STEMI diagnosis and an additional 83 min (1.3 h) from diagnosis to revascularization, totaling a supplementary ischemic time of 3.1 h. In total, 41.5% of the patients were revascularized between 2 and 6 h from symptoms onset. The objective of revascularization in less than 120 min (from first medical contact) was accomplished in 35.5% of the patients. Prehospital thrombolysis was performed in 6.4% of the cases, although its potential benefits could have been expected in 64.5% of the patients.</p>
</sec>
<sec><h3>Conclusions</h3>
<p>Patients with STEMI arrive predominantly via secondary routes to the PCI center, which implies significantly increased ischemic times. The ambulance alert system and primary routes represent by far the most efficient, albeit still imperfect methods of pre-hospital approach. Prehospital thrombolysis did not compensate for the gaps existing in the performance of the current system.</p>
</sec>
</abstract>

Background
Time intervals related to ST-segment myocardial infarction (STEMI) revascularization are central determinants for patient outcomes. The current capability of the Romanian STEMI program to meet guideline-recommended time intervals is largely unknown.

Aims
The present study aims to assess the ability of a regional STEMI network to obtain guideline-recommended time intervals for primary percutaneous coronary intervention (pPCI) and to measure the occurrence and the extent of time delays.

Materials and Methods
This prospective study included 500 consecutive patients with STEMI at the “Prof. Dr. C.C. Iliescu” Emergency Institute for Cardiovascular Diseases, Bucharest, Romania during a period of 14 months. Complete ischemic timelines were created using several key timepoints.

Results
A secondary route (transfer from another hospital) was noted in most cases. The main time intervals were the following: patient delay 209 min, emergency medical system delay 66 min, and PCI center delay at 70 min, totaling an ischemic time of 6.4 h. A provisional stop at another hospital involved the addition of 113 min (1.8 h) until STEMI diagnosis and an additional 83 min (1.3 h) from diagnosis to revascularization, totaling a supplementary ischemic time of 3.1 h. In total, 41.5% of the patients were revascularized between 2 and 6 h from symptoms onset. The objective of revascularization in less than 120 min (from first medical contact) was accomplished in 35.5% of the patients. Prehospital thrombolysis was performed in 6.4% of the cases, although its potential benefits could have been expected in 64.5% of the patients.

Conclusions
Patients with STEMI arrive predominantly via secondary routes to the PCI center, which implies significantly increased ischemic times. The ambulance alert system and primary routes represent by far the most efficient, albeit still imperfect methods of pre-hospital approach. Prehospital thrombolysis did not compensate for the gaps existing in the performance of the current system.

Critical Appraisal of Medical System Performance for STEMI Management – a Comprehensive Analysis of Time Efficiency

“Carol Davila” University of Medicine and Pharmacy

Journal of Cardiovascular Emergencies

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Background
Time intervals related to ST-segment myocardial infarction (STEMI) revascularization are central determinants for patient outcomes. The current...

Critical Appraisal of Medical System Performance for STEMI Management – a Comprehensive Analysis of Time Efficiency

Article Category: Original Research

Published Online: Mar 21, 2024

Page range: 27 - 37

Received: Dec 21, 2023

Accepted: Mar 08, 2024

DOI: https://doi.org/10.2478/jce-2024-0008

Keywords
STEMI, time intervals, primary PCI, patient delay, emergency system delay

© 2024 Silviu Dumitraşcu et al., published by Sciendo

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Critical Appraisal of Medical System Performance for STEMI Management – a Comprehensive Analysis of Time Efficiency

Article Category: Original Research

Published Online: Mar 21, 2024

Page range: 27 - 37

Received: Dec 21, 2023

Accepted: Mar 08, 2024

DOI: https://doi.org/10.2478/jce-2024-0008

KeywordsSTEMI, time intervals, primary PCI, patient delay, emergency system delay

© 2024 Silviu Dumitraşcu et al., published by Sciendo

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Keywords
STEMI, time intervals, primary PCI, patient delay, emergency system delay