Referral pathway in primary PCI - delays depend on the origin

Abstract

Abstract Background Ischaemic heart disease is the single most common cause of death and its frequency is increasing. The mortality in patients presenting with an acute coronary syndrome with ST-elevation (STEMI) is associated with many factors such as the time delay to treatment, which comprises primary angioplasty (pPCI) or fibrinolysis. Therefore, treatment delays should be recorded systematically and audited, so as to improve standard of care. Purpose To analyse the response time and delays in the emergent coronary referral pathway for our centre, taking into consideration the place of first contact. Methods Primary data for this study was obtained by evaluating consecutive patients from the year 2015 to 2021, admitted for pPCI in our centre in the context STEMI. Time variables were collected for all patients – schematically represented in Figure 1. Statistical analyses were performed using IBM SPSS Statistics for Windows Version 27.0. Results We included a total of 1452 cases of pPCI with a median patient age of 64 years and 75,3% male. Over 7 years of pPCI were analysed and median times are displayed in table 1. We found that ECG median delays were significantly lower in the emergency first responders (EFR) group when comparing to PCI Centre group (11,0 vs 22,0; p<0,001), primary care physicians group(11,0 vs 23,0; p<0,001) and non-PCI Centre group (11,0 vs 28,0; p<0,001). Futhermore, median diagnostic delay was significantly lower in the EFR group compared to non-PCI centre group (28,0 vs 62,0; p<0,001) and primary care physician group (28,0 vs 59,0; p<0,001), as well as in the PCI Centre group compared to the non-PCI Centre group (30,0 vs 62,0; p<0,001) and to primary care physician group (30,0 vs 59,0; p<0,001). Conclusions Our data displays a clear heterogeneity in care which has an impact in the ischaemic time of STEMI patients. There seems to be a significant difference between the primary point of contact being the primary care physicians or a non-PCI centre when compared to our centre or the EFR, especially when it comes to the diagnostic timings. Hence, strategies must be developed to increase diagnostic sensibility and accuracy of STEMI patients throughout our geographical region.Time variable schemeTime according to groups