Critical Appraisal of Medical System Performance for STEMI Management – a Comprehensive Analysis of Time Efficiency
, , , , and | Mar 21, 2024
About this article
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
© 2024 Silviu Dumitraşcu et al., published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.
FIGURE 1.
FIGURE 2.
FIGURE 3.
Total ischemic time by categories of time intervals as a function of method of arrival
| By ambulance | 4.6% | 58% | 29% | 8.4% |
| Transfer from another hospital | 0.5% | 31% | 50.2% | 18% |
Comparison of time intervals between the two methods of arrival at the PCI center. Values are expressed in min (medians).
| Symptoms to ambulance (time to FMC) | 126 (53–257) | N/A | N/A |
| Symptoms to first ECG | 132 (78–327) | 245 (120–465) | 0.003 |
| Ambulance to hospital | 60 (40–95) | N/A | N/A |
| Symptoms to hospital arrival | 203 (126–371) | 372 (260–614) | <0.0001 |
| First ECG to hospital arrival (EMS delay) | 40 (5–76) | 119 (53–204) | <0.0001 |
| Hospital arrival to arterial access (ED delay) | 39 (27–60) | 46 (33–71) | 0.08 |
| Hospital arrival to wire passage | 57 (45–78) | 66 (50–92) | 0.04 |
| Arterial access to wire passage | 17 (13–24) | 18 (14–24) | 0.07 |
| Arterial access to revascularization | 24 (18–32) | 25 (20–33) | 0.33 |
| Wire passage to revascularization | 5 (3–10) | 5 (3–10) | 0.99 |
| Ambulance to revascularization (FMC to revascularization) | 134 (109–197) | N/A | N/A |
| First ECG to wire crossing | 112 (71–160) | 190 (114–268) | <0.0001 |
| First ECG to revascularization | 117 (73–167) | 200 (117–290) | <0.0001 |
| Hospital arrival to revascularization (door-to-balloon time) | 63 (49–88) | 72 (55–99) | 0.06 |
| Symptoms onset to revascularization(TIT) | 260 (199–441) | 453 (333–635) | <0.0001 |
General patient characteristics and admission details
| Male sex | 373 (74.6%) |
| Age (years) | 61.7 ± 12.08 |
| ≥80 | 51 (10.2%) |
| <40 | 10 (2%) |
| Body mass index (kg/m2) | 28 ± 5.1 |
| >30 | 153 (30.6%) |
| Smoking (at any time) | 317 (63.4%) |
| Current smoker | 251 (50.2%) |
| Former smoker | 66 (13.2%) |
| Never | 183 (36.6%) |
| Hypertension | 376 (75.2%) |
| Diabetes mellitus | 117 (23.4%) |
| Chronic obstructive pulmonary disease | 8 (1.6%) |
| Moderate or severe chronic kidney disease | 37 (7.4%) |
| Previous stroke | 9 (1.8%) |
| Previous myocardial infarction | 33 (6.6%) |
| Heart failure | 24 (4.8%) |
| Atrial fibrillation or atrial flutter | 14 (2.8%) |
| Previous percutaneous coronary intervention | 33 (6.6%) |
| Previous coronary artery bypass grafting | 1 (0.2%) |
| Presenting symptoms | |
| Chest pain | 465 (93%) |
| Dyspnea | 10 (2.0%) |
| Cardiac arrest | 21 (4.2%) |
| Other | 4 (0.8%) |
| Cardiac arrest prior to hospital arrival | 38 (7.6%) |
| Prehospital thrombolysis | 32 (6.4%) |
| Heart rate | 84.8 ± 19.8 |
| Systolic blood pressure | 137.9 ± 27.5 |
| Killip class | |
| I | 419 (83.8%) |
| II | 33 (6.6%) |
| III | 21 (4.2%) |
| IV | 27 (5.4%) |
| Hemoglobin (g/dl) | 14.4 ± 1.9 |
| Creatinine (mg/dl) | 0.98 ± 0.5 |
| LDL cholesterol (mg/dl) | 160 ± 51.6 |
| TTE assessment at ED | 500 (100%) |
| Left ventricular ejection fraction | |
| >50% | 121 (24.2%) |
| 40–50% | 142 (28.4%) |
| 30–40% | 186 (37.2%) |
| <30% | 51 (10.2%) |
| ST-segment elevation on ECG | |
| Inferior | 225 (45%) |
| Anterior | 215 (43%) |
| Other | 60 (12%) |
| ECG – QRS morphology | |
| Normal | 389 (77.8%) |
| Q waves | 85 (17%) |
| LBBB | 9 (1.8%) |
| RBBB | 15 (3%) |
| Pacing | 2 (0.4%) |
| Other | |
| ECG – rhythm | |
| Sinus rhythm | 459 (91.8%) |
| Atrial fibrillation | 30 (6%) |
| Other | 11 (2.2%) |
Achievement of target time intervals in patients who underwent pPCI
| FMC to ECG | ≤10 min | 63 (40.3%) |
| Diagnostic to wire passage (overall) | ≤120 min | 159 (35.5%) |
| Diagnosis to wire passage (for self-presenters) | ≤60 min | 14 (29.1%) |
| ≤120 min | 29 (60.4%) | |
| Diagnosis to wire passage (for ambulance arrival) | ≤120 min | 73 (46.7%) |
| Diagnosis to wire passage (for transfers) | ≤120 min | 56 (18.9%) |
| Door-to-balloon | ≤90 min | 300 (67.1%) |
Emergency coronary angiography findings and PCI procedural findings
| Overall coronary findings | 373 (74.6%) |
| Normal | 14 (2.8%) |
| 1-vessel disease | 261 (52.2%) |
| 2-vessel disease | 133 (26.6%) |
| 3-vessel disease | 63 (12.6%) |
| LM + 1-vessel disease | 5 (1%) |
| LM + 2-vessel disease | 10 (2%) |
| LM + 3-vessel disease | 14 (2.8%) |
| Spontaneous coronary artery dissection | 0 |
| Culprit vessel | 183 (36.6%) |
| RCA | 243 (41.7%) |
| LAD | 226 (38.8%) |
| Cx | 96 (16.5%) |
| LM | 14 (2.4%) |
| RI | 4 (0.7%) |
| TIMI flow | |
| TIMI 0 | 62.60% |
| TIMI 1 | 9.30% |
| TIMI 2 | 18.40% |
| TIMI 3 | 9.80% |
| In-stent restenosis | 10 (2%) |
| In-stent thrombosis | 6 (1.2%) |
| Percutaneous coronary intervention | 10 (2.0%) |
| During index procedure | 477 (95.4%) |
| Planned after discharge | 6 (1.2%) |
| Not performed/planned | 17 (3.4%) |
| PCI attempted | 477 (95.4%) |
| Primary PCI | 447 (93.7%) |
| Rescue PCI | 27 (5.6%) |
| Pharmacoinvasive strategy | 3 (0.62%) |
| Arterial access | |
| Radial artery | 306 (61.2%) |
| Femoral artery | 194 (38.8%) |
| Adjuvant therapies/equipment | 84 (16.8%) |
| Thrombectomy | 84 (16.8%) |
| Angioplasty with at least one stent (no. of patients) | 428 |
| One stent | 333 |
| Two stents | 82 |
| Three stents | 9 |
| Four stents | 4 |
| Median stent length (mm) | 23.18–28] |
| Median stent diameter (mm) | 3.3–3.5] |
| Lesions treated with DEB | 3 (0.5%) |
| Median DEB diameter | 2.5.2.5–2.5] |
| POBA | 33 (5.7%) |
| Successful PCI | 461 (96.6%) |
| Any periprocedural events | 37 (7.4%) |
| Type of periprocedural events | 60 (12%) |
| Bradyarrhythmia requiring pacing | 5 (1%) |
| Arrhythmia requiring cardioversion | 5 (1%) |
| Coronary perforation | 1 (0.2%) |
| Coronary dissection persisting | 1 (0.2%) |
| Access site-related complication | 3 (0.6%) |
| Stroke/TIA | 1 (0.2%) |
| Cardiogenic shock | 11 (2.2%) |
| Death | 3 (0.6%) |
| Other | 7 (1.4%) |
| Complete revascularization | 269 (53.8%) |
| Glycoprotein IIb/IIIa inhibitors | 0 |
| Pharmacological vascular support | 27 (5.4%) |
| Any mechanical circulatory support | 13 (2.6%) |
| Mechanical circulatory support type | |
| IABP | 10 (2%) |
| ECMO | 3 (0.6%) |