Abstract
This study is aimed at assessing trends and relations between total ischemic time, the major quality measure of systemic delay, and case-fatality at the population or patient level in response to growing cardiovascular risk and a constant need to shorten the time to treatment in ST-segment elevation myocardial infarction (STEMI). Data from a prospective nationwide registry of STEMI patients admitted between 2006 and 2013 who were treated with primary percutaneous coronary intervention (PCI) were analyzed. Total ischemic time was calculated as the time from the onset of symptoms to primary PCI and was determined as individual and annual. The primary end-point was one-year, all-cause case-fatality. Among the total 70,093 analyzed patients, temporal trends showed significant decrease in total ischemic time (268 vs. 230 minutes, p < 0.001), a worsening of the risk profile and an increase in one-year case-fatality (7.1% vs. 10.8%, p < 0.001). In the multivariate analysis, longer individual total ischemic time was a risk factor for higher mortality (HR 1.024, 95%CI 1.015–1.034, p < 0.001) and remained significant after adjustment for the year of admission. An inverse relation was observed for the median annual time (HR 0.992, 95%CI 0.989–0.994, p < 0.001). Thus, the observed increasing annual trends in case-fatality cannot directly measure the quality of STEMI network performance.
Highlights
Over the past years, an incremental improvement in the efficiency of treatment in ST-segment elevation myocardial infarction (STEMI) has been achieved worldwide
The percentage of primary percutaneous coronary intervention (PCI) procedures in patients admitted with STEMI increased in Poland from 46% in 2006 to 79% in 2013, and the global one-year case-fatality in the STEMI population has significantly decreased over the years [1,2]
From the total of 132,715 STEMI patients reported to the registry from 2006 to 2013, 98,766 were uncertain time-point time-point data, data, treated with primary PCI
Summary
An incremental improvement in the efficiency of treatment in ST-segment elevation myocardial infarction (STEMI) has been achieved worldwide. The percentage of primary percutaneous coronary intervention (PCI) procedures in patients admitted with STEMI increased in Poland from 46% in 2006 to 79% in 2013, and the global one-year case-fatality in the STEMI population has significantly decreased over the years [1,2]. Reported early or long-term case fatality rates are still used and considered one of the major measures in the assessment of the quality of care in STEMI. Considering the constantly growing risk profile of populations, there is a need for careful evaluation and interpretation of annual fatality trends.
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