Percutaneous Coronary Intervention Facilities Research Articles

Percutaneous coronary intervention facilities in Nigeria.

In Nigeria, the incidence of coronary artery disease has doubled over the last three decades. However, there appears to be a lack of adequate heart catheterisation facilities. A list of percutaneous coronary intervention (PCI)-capable facilities was compiled for each state in Nigeria and the federal capital territory. Population estimates for 2019 were obtained from the National Bureau of Statistics and this was utilised to calculate the number of PCI facilities per person in each state and the country. There are 12 operational PCI facilities in Nigeria, 11 of which are in the private health sector. Overall, there is one PCI facility per 16 761 272 people in Nigeria. There is a distinct lack of PCI-capable facilities in Nigeria. There needs to be an investment from the government and stakeholders in Nigeria to increase the access to PCI, given the paradigm shift from communicable to noncommunicable diseases.

209EMF Uninsured Patients Diagnosed With ST-Elevation Myocardial Infarction Present to Lower Volume and Lower Quality Percutaneous Coronary Intervention Facilities

209EMF Uninsured Patients Diagnosed With ST-Elevation Myocardial Infarction Present to Lower Volume and Lower Quality Percutaneous Coronary Intervention Facilities

Assessing the condition of percutaneous coronary intervention services in Africa: challenges and prospects for advancement - a review.

This study assesses the state of percutaneous coronary intervention (PCI) services in Africa, identifying the challenges and prospects for improvement. The study highlights limited infrastructure, resources, and the healthcare workforce as significant challenges in providing adequate PCI services to the population. However, opportunities for improvement are available through increased investment in healthcare infrastructure, healthcare professional training programs, and telemedicine. Collaboration among governments, healthcare providers, and international organizations is essential to address these challenges and improve access to high-quality PCI services for all Africans. Improving PCI facilities and utilization will not only benefit current and future patients with cardiovascular disease but will also advance healthcare as a whole in Africa.

Recurrence of Protruding Calcified Nodule Visualized Using Optical Coherence Tomography Following Stent Implantation

Disparities in access to percutaneous coronary intervention (PCI) for patients with acute myocardial infarction may result from openings and closures of PCI-providing hospitals, potentially leading to low hospital PCI volume, which is associated with poor outcomes.The authors sought to determine whether openings and closures of PCI hospitals have differentially impacted patient health outcomes in high- vs average-capacity PCI markets.In this retrospective cohort study, the authors identified PCI hospital availability within a 15-minute driving time of zip code communities. The authors categorized communities by baseline PCI capacity and identified changes in outcomes associated with PCI-providing hospital openings and closures using community fixed-effects regression models.From 2006 to 2017, 20% and 16% of patients in average- and high-capacity markets, respectively, experienced a PCI hospital opening within a 15-minute drive. In average-capacity markets, openings were associated with a 2.6 percentage point decrease in admission to a high-volume PCI facility; high-capacity markets saw an 11.6 percentage point decrease. After an opening, patients in average-capacity markets experienced a 6.5% and 8.6% relative increase in likelihood of same-day and in-hospital revascularization, respectively, as well as a 2.5% decrease in mortality. PCI hospital closures were associated with a 10.4% relative increase in admission to high-volume PCI hospitals and a 1.4 percentage point decrease in receipt of same-day PCI. There was no change observed in high-capacity PCI markets.After openings, patients in average-capacity markets derived significant benefits, whereas those in high-capacity markets did not. This suggests that past a certain threshold, facility opening does not improve access and health outcomes.

Do PCI Facility Openings and Closures Affect AMI Outcomes Differently in High- vs Average-Capacity Markets?

BackgroundDisparities in access to percutaneous coronary intervention (PCI) for patients with acute myocardial infarction may result from openings and closures of PCI-providing hospitals, potentially leading to low hospital PCI volume, which is associated with poor outcomes. ObjectivesThe authors sought to determine whether openings and closures of PCI hospitals have differentially impacted patient health outcomes in high- vs average-capacity PCI markets. MethodsIn this retrospective cohort study, the authors identified PCI hospital availability within a 15-minute driving time of zip code communities. The authors categorized communities by baseline PCI capacity and identified changes in outcomes associated with PCI-providing hospital openings and closures using community fixed-effects regression models. ResultsFrom 2006 to 2017, 20% and 16% of patients in average- and high-capacity markets, respectively, experienced a PCI hospital opening within a 15-minute drive. In average-capacity markets, openings were associated with a 2.6 percentage point decrease in admission to a high-volume PCI facility; high-capacity markets saw an 11.6 percentage point decrease. After an opening, patients in average-capacity markets experienced a 6.5% and 8.6% relative increase in likelihood of same-day and in-hospital revascularization, respectively, as well as a 2.5% decrease in mortality. PCI hospital closures were associated with a 10.4% relative increase in admission to high-volume PCI hospitals and a 1.4 percentage point decrease in receipt of same-day PCI. There was no change observed in high-capacity PCI markets. ConclusionsAfter openings, patients in average-capacity markets derived significant benefits, whereas those in high-capacity markets did not. This suggests that past a certain threshold, facility opening does not improve access and health outcomes.

Characterization of prehospital time delay in primary percutaneous coronary intervention for acute myocardial infarction: analysis of geographical infrastructure-dependent and -independent components

BackgroundPrehospital delay in reaching a percutaneous coronary intervention (PCI) facility is a major problem preventing early coronary reperfusion in patients with ST-elevation myocardial infarction (STEMI). The aim of this study was to identify modifiable factors that contribute to the interval from symptom onset to arrival at a PCI-capable center with a focus on geographical infrastructure-dependent and -independent factors.MethodsWe analyzed data from 603 STEMI patients who received primary PCI within 12 h of symptom onset in the Hokkaido Acute Coronary Care Survey. We defined onset-to-door time (ODT) as the interval from the onset of symptoms to arrival at the PCI facility and we defined door-to-balloon time (DBT) as the interval from arrival at the PCI facility to PCI. We analyzed the characteristics and factors of each time interval by type of transportation to PCI facilities. In addition, we used geographical information system software to calculate the minimum prehospital system time (min-PST), which represents the time required to reach a PCI facility based on geographical factors. We then subtracted min-PST from ODT to find the estimated delay-in-arrival-to-door (eDAD), which represents the time required to reach a PCI facility independent of geographical factors. We investigated the factors related to the prolongation of eDAD.ResultsDBT (median [IQR]: 63 [44, 90] min) was shorter than ODT (median [IQR]: 104 [56, 204] min) regardless of the type of transportation. However, ODT was more than 120 min in 44% of the patients. The min-PST (median [IQR]: 3.7 [2.2, 12.0] min) varied widely among patients, with a maximum of 156 min. Prolongation of eDAD (median [IQR]: 89.1 [49, 180] min) was associated with older age, absence of a witness, onset at night, no emergency medical services (EMS) call, and transfer via a non-PCI facility. If eDAD was zero, ODT was projected to be less than 120 min in more than 90% of the patients.ConclusionsThe contribution of geographical infrastructure-dependent time in prehospital delay was substantially smaller than that of geographical infrastructure-independent time. Intervention to shorten eDAD by focusing on factors such as older age, absence of a witness, onset at night, no EMS call, and transfer via a non-PCI facility appears to be an important strategy for reducing ODT in STEMI patients. Additionally, eDAD may be useful for evaluating the quality of STEMI patient transport in areas with different geographical conditions.

Evaluation of Mortality Frequency in Cardiogenic Shock in Anterior Wall Myocardial Infarction in the Patients Presented to Lady Reading Hospital, Peshawar

Background: The insufficient supply oxygen and blood to the myocardium is characterized by the coronary artery disease. The coronary arteries occlusion leads to this condition. The plaques formation in coronary arteries lumen is indicative of the condition. These plaques impede blood flow. It is a major concern worldwide. Objective: To evaluate the mortality frequency in cardiogenic shock in anterior wall myocardial infarction in patients presenting to Lady Reading Hospital, Peshawar. Study Design: It is a descriptive case study conducted at department of Cardiology, Lady Reading Hospital Peshawar and NICVD, Nawabshah. This study was conducted from 1st June 2021 to 30th November 2021. Subjects and Methods: A total of 139 patients diagnosed with cardiogenic shock were selected for the study. According to the operational definition the followed up of all patients till discharge and mortality was recorded. Results: The age range of the patients selected for the study was 18-70 years. The mean of age was 47.841±6.66 years, mean weight 83.259±7.39 Kg and mean duration of symptoms was 8.870±3.76 hours. Male patients were 77.7% and females were 22.3%. Mortality was seen in 20.9% patients. Conclusion: Patients with anterior wall myocardial infarction and cardiogenic shock undergoing percutaneous coronary intervention have better clinical out-comes. The decreased mortality is also observed. Without the delay of time the patients must be transferred to the primary percutaneous coronary intervention facility if it is far away. There is need to establish more primary percutaneous coronary intervention centers. Keywords: Anterior wall myocardial infarction, cardiogenic shock, mortality.

Inter-facility transfer for patients with STEMI in Bahrain: Characteristics and timings

Background: The outcomes of patients with ST-elevation myocardial infarction (STEMI) transferred to percutaneous coronary intervention (PCI) facility is strongly related to certain demographic and clinical factors, important timelines, door-to-electrocardiography (ECG) time, door-in door-out (DIDO) time, door to balloon time (DTBT), the use of emergency medical services (EMS), and the existence of a STEMI network. In the study, we examined the inter-facility transfer for patients with STEMI analyzing certain characteristics and timings between the involved institutions. Method: This was a retrospective observational study on the inter-facility transfer of patients with STEMI admitted between January 01, 2018, and December 31, 2019. The electronic medical records of both the institutions were used to collect data on patient demographics, clinical characteristics and scores, ECG manifestations, laboratory values, treatment interventions, and outcomes with a major focus on the timelines for door-to-ECG, DIDO, and DTBT. Results: A total of 141 patients with STEMI who were transferred to a PCI center were included in this study. Their mean age was 52.26 ± 12.45 years and were mainly men (87.9%, p < 0.001). Men developed STEMI at a younger mean age (53.15 ± 12.53 years, p = 0.003). Chest pain was the most common notable symptom (129, 91.5%). Diabetes mellitus (DM) and hypertension were noted to be the comorbid factors in a majority of patients (70, 49.6%). Only 47 patients (33.3%, p < 0.001) were brought by EMS. Mean door-to-ECG and DIDO times were 8 minutes (IQR: 4–12) and 32.5 minutes (IQR: 24–46), respectively. Only 112 patients (79.4%) underwent PCI on arrival with a DTBT of 90 minutes (IQR: 70.5–105). Only door-to-ECG time and DTBT could be attained as required in this study (p < 0.001). Conclusion: This study reveals a few beneficial statistics for the inter-facility transfer of patients with STEMI concerning their demographics, clinical characteristics, and important timelines. The door-to-ECG time, DTBT, and DIDO time were in the considerable recommended time, and this reflects the importance of establishing a STEMI network.

Abstract 11426: Processes and Outcomes for 121,576 Patients With ST Elevation Myocardial Infarction in the AHA Get With the Guidelines®-Coronary Artery Disease (GWTG-CAD) Registry, 2018-2021

Introduction: Timely treatment of ST elevation myocardial infarction [STEMI] requires ongoing coordinated care between emergency departments, paramedics, and primary percutaneous coronary (PCI) intervention facilities. Methods: To provide a current view and a national benchmark, we examined 121,576 patient records submitted by 648 hospitals participating the GWTG-CAD registry from Q2 2018 through Q3 2021 [median age 63, women 29%, Black 11%, Hispanic 8%, admission cardiac arrest 5%, shock 7%, heart failure 7%, Covid 0.2%, presentation EMS 47%, walk in 27%, transfer 22%] Results: Reperfusion method for all patients included primary PCI 87%, fibrinolysis 5%, and no reperfusion 8% [increasing from 7 to 9% during the study period]. Median time from symptom onset to reperfusion was shortest for EMS patients 148 minutes, followed by walk-in 195 minutes, ground transferred 238 minutes, and air transferred 247 minutes. Process times did not improve during the study period. First medical contact to device times increased by 5 minutes for EMS and ground transferred patients in Q2 2020 corresponding with the pandemic onset, and adjusted mortality was significantly higher in the final 3 quarters compared to Q2 2018 [OR, 95% CI 1.28(1.07-1.53); 1.35(1.13-1.61); 1.23(1.03-1.48)]. Patients treated within guideline goals had significantly lower mortality [Figure]. Conclusions: These data reaffirm the association between process times and lower mortality for STEMI patients. They also identify concerning trends and opportunities for improved care. Increasing delays in treatment, particularly for hospital transfer, greater numbers of untreated patients, and increased risk-adjusted in-hospital mortality all provide strong impetus for renewed focus on STEMI systems. Regional collaborative efforts led by coordinators and informed by a common data system have the potential to reverse these trends and improve survival.

Intracoronary epinephrine during cardiac resuscitation for patients undergoing percutaneous coronary intervention for acute myocardial infarction (iCPR study)

Abstract Background Despite significant progress in cardiopulmonary resuscitation (CPR), outcomes remain relatively poor. Epinephrine administration remains a cornerstone in the treatment of in-hospital cardiac arrest. Various routes of administration, including intravenous, intramuscular, intraosseous and endotracheal routes have been studied; however, the optimal route is debated. Purpose The purpose of this study was to compare patient outcomes following peripheral intravenous (IV), central IV, or arterial intracoronary (IC) epinephrine administration in patients undergoing CPR in the catheterization laboratory. Methods This was a prospective two-center pilot cohort study conducted in high-volume percutaneous coronary intervention (PCI) facilities in the republic of Lithuania. The study enrolled patients with acute myocardial infarction (AMI) who suffered a cardiac arrest in the cardiac catheterization laboratory during PCI. Cardiac resuscitation was performed according to the European Resuscitation Council Guidelines. Central IV was the first choice for epinephrine administration if it was available. However, in cases without central access, the route of epinephrine administration (peripheral IV or arterial IC) was at the discretion of the physician. The primary endpoint was the rate of return of spontaneous circulation (ROSC). We tested for overall differences in patient characteristics and outcomes between groups using Chi-Square (or Kruskal-Wallis) tests and used the Holm-Bonferroni adjustment (or Dunn's tests) for subsequent pairwise tests. We also performed logistic regression. Results There were 158 participants in this study, with 48 (30.4%), 50 (31.6%), and 60 (38.0%) receiving epinephrine via central IV, IC, and peripheral IV routes, respectively. The median age was 71 [61, 80] years and 56% of participants were men. Patient characteristics were similar across routes, except for age (higher for peripheral IV than IC), serum potassium (although no significant post-hoc differences), hemoglobin (lowest in peripheral route), and heart rhythm before CPR (higher rates of electromechanical dissociation in peripheral route). There were 111 (70%) patients who achieved the primary outcome of ROSC (Table 1). Peripheral IV administration was associated with 7-fold decreased odds of achieving ROSC (odds ratio = 0.14, 95% confidence interval = 0.05–0.36, p<0.0001) compared to central IV (no difference between central IV and IC; p=0.9343). By itself, adrenaline route yielded an area under the receiver operating characteristic curve of 0.73, indicating good predictive ability. Conclusion Epinephrine administration route was a significant predictor of ROSC for patients with AMI undergoing CPR in the catheterization laboratory. ROSC rates for patients who received epinephrine via IC or central IV were superior to those who received it via peripheral IV. Funding Acknowledgement Type of funding sources: Foundation. Main funding source(s): Baylor Health Care System Foundation (USA)National Interventional Cardiology Association (Lithuania)

Thrombolysis in the de winter electrocardiography pattern: A therapeutic dilemma

The de Winter's pattern is an electrocardiography (ECG) finding characterized by ST depression and tall prominent T-waves in precordial leads with ST elevation in lead aVR. It signifies the occlusion of proximal left anterior descending artery (LAD). Although it is considered a ST-elevation myocardial infarction (STEMI) equivalent, current guidelines recommend against the use of thrombolytic therapy in the absence of STEMI. As the question whether to use thrombolysis in such situations remains unanswered and controversial, we preferred to provide thrombolytic therapy with tenecteplase to our patient admitted with acute retrosternal chest pain with de Winter's ECG pattern so as to prevent myocardial damage and improve the patient outcome as the percutaneous coronary intervention facility was not immediately available. The thrombolysis was successful and the proximal LAD occlusion was confirmed later on coronary angiography which was treated with stent implantation. This case report tends to highlight the therapeutic dilemma while managing patients with de Winter's ECG pattern.

English

BACKGROUND Cardiac biomarkers like troponin play a very important role in the diagnosis of acute myocardial infarction. In a developing country like India, though the burden of cardiovascular diseases is on the rise, majority of the patients with acute coronary syndrome do not have access to primary percutaneous coronary intervention (PCI) facilities. Few Indian studies have looked into the utility of the quantitative troponin levels in predicting the cardiovascular outcome of non-ST segment elevation myocardial infarction / ST segment elevation myocardial infarction STEMI / NSTEMI patients; this study was conducted to find out the same. METHODS A retrospective analysis of the medical records of intensive care units (ICU) patients more than 18 years of age admitted with diagnosis of STEMI / NSTEMI for a duration of 12 months was done. The comorbidities, treatment, coronary artery disease (CAD) risk factors, cardiovascular complications and quantitative troponin levels were noted. RESULTS Retrospective analysis of 124 patient records was done which revealed that 74.8 % presented with STEMI and the rest were diagnosed to have NSTEMI. 39.5 % were hypertensive and 47 % were diabetic. The mean troponin values were higher in the patients who died and developed cardiac complications like left ventricular failure and cardiogenic shock. However, statistical significance was seen only for troponin values and left ventricular failure (LVF). CONCLUSIONS The quantitative levels of a simple biomarker like troponin I used for the diagnosis of acute myocardial infarction could also be used to predict the cardiovascular outcome and prognosis of the patient. A higher baseline troponin value during the diagnosis could possibly alert the treating primary physician for a referral to a specialised cardiac centre and likely need for early revascularisation, which is of importance in a developing country like India with compromised resources. KEYWORDS Quantitative Troponin I, STEMI, NSTEMI

Assessment of Transportation by Air for Patients with Acute ST-Elevation Myocardial Infarction from Non-PCI Centers.

The aim of this study was to assess the delays that can potentially occur in the emergency transfer of patients with ST-elevation myocardial infarction (STEMI) to percutaneous coronary intervention (PCI) centers. We conducted a retrospective study using the medical reports pertaining to 97 patients who presented to the Emergency Department of the Emergency County Hospital of Galati during the year of 2018 with the diagnosis of STEMI and meeting eligibility criteria for PCI, thus warranting transfer to a hospital with PCI facilities. The pick-up time of patients diagnosed with acute myocardial infarction from the emergency department by the transfer crew is significantly shorter (p < 0.05) than those transferred by air, regardless of the PCI center to which the transfer was performed, Iasi or Bucharest, when compared to the time required to process the patients transferred by land to the same PCI centers. The results of the study shows that the helicopter use for transferring acute myocardial infarction patients to a PCI center must be considered, given the distance between non-PCI and PCI centers is over 200 km.

Role of Intravascular Ultrasound in Prediction of Acute Side Branch Occlusion in Coronary Artery Bifurcation Lesions Just After Provisional Stenting

Background: Coronary bifurcation lesion is important subject in percutaneous coronary intervention (PCIs). While much progress has been made in PCI facilities, bifurcation stenting is still has a lot of problems. Objectives: The aim of this study was the usefulness of intravascular ultrasound (IVUS) to help in the prediction of occlusion of side branch (SB) after stenting the main vessel (MV) in bifurcation lesions. Patients and methods: The period of this study was from May 2019 to December 2020, and included 80 patients who were submitted for elective coronary angiography to the cardiology department at Maadi Military Hospital, and showed bifurcation lesions treated with provisional stenting using IVUS measurements. Results: This study included two groups according to the occlusion of SB after main vessel stenting .The 1st group had the patients with occlusion of SB (n= 18) and the 2nd group had the patients without occlusion of SB (n= 62). The thinner plaque of main vessel (MV) at junction position with SB, MV plaque area and diameter ratio of SB were the factors which could predict acute occlusion of SB after provisional stenting. Conclusion: In coronary bifurcation lesions, we can use intravascular ultrasound (IVUS) to help in the prediction of occlusion of SB after provisional stenting, and these predictors can help the operators to prepare the best strategy for treating bifurcation lesions.

Use of the Left Radial Artery as Vascular Access for Coronary Angiography and as a Bypass Conduit: A Clinical Dilemma?

PurposeInternational coronary revascularization guidelines recommend both, transradial vascular access for coronary angiography/intervention and use of the radial artery as a conduit for coronary artery bypass grafting (CABG). These recommendations may pose a clinical dilemma, as transradial access exposes these arteries to vascular trauma which makes them potentially unsuitable as future grafts. In this study, we investigated the awareness and views of cardiologists on these guideline recommendations. MethodsWe performed semi-structured interviews with 50 cardiologists from 19 centers, who regularly perform coronary angiographies or interventions, and outlined clinical scenarios to evaluate their preference of vascular access. In addition, we assessed whether preference was related to sub-specialization. ResultsThe interviewed cardiologists had 16 ± 9.3 years of professional experience. There were 23 (46%) cardiologists from 7 centers without percutaneous coronary intervention facilities, and 27 (56%) cardiologists from 12 interventional centers. All 50 (100%) cardiologists indicated familiarity with the guidelines, yet 28 (56%) said not to be familiar with the aforementioned dilemma, and 9 (18%) stated there was no dilemma at all. Responses did not differ significantly between interventional (n = 28) and non-interventional (n = 22) cardiologists; however, if the right radial artery was unavailable (e.g., occluded), interventional cardiologists more often said to prefer access via the left radial artery (18/28 (64%) vs. 5/22 (23%), p = 0.001). ConclusionMore than half of the interviewed cardiologists indicated that they had not realized that left transradial access preceding CABG may preclude later use of this artery as a conduit. Notably, in case of unavailability of the right radial artery, interventional cardiologists preferred left transradial access more often than non-interventional cardiologists.

COVID-19 and cardiac health: A review

The ongoing novel coronavirus pandemic has caused a serious impact on patients suffering from cardiovascular disorders as they are predisposed to COVID infection as well as to exacerbation of their preexisting conditions which can prove to be fatal. Novel coronavirus disease-2019 (nCOVID-19) has a varied effect on the cardiac system ranging from myocardial injury to thromboembolic complications. A significant proportion of patients are noted to have comorbidities. Human angiotensin-converting enzyme 2 (ACE 2) receptor is considered the target of the severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2). SARS-Cov-2 leads to imbalance in RAAS activity which is responsible for target organ damage. Recombinant ACE 2 has been shown to restore ACE 2 levels in explanted hearts and restore balanced RAAS activity. nCOVID-19 can have varied cardiac manifestations ranging from acute coronary syndrome to heart failure, arrhythmias, pulmonary thromboembolism, and pericarditis. The current nCOVID-19 pandemic has led to changes in management strategies for cardiovascular diseases. Patients with ST-elevation myocardial infarction can be fibrinolysed when a primary percutaneous coronary intervention facility with adequate protection is not available. Angiotensin-converting enzyme inhibitor/angiotensin receptor blocker needs to be continued in patients with hypertension. Continuity of care for patients with chronic cardiovascular illness needs to be maintained. Management of cardiovascular emergencies needs to be done in a way which ensures the safety of health-care professionals and prevents infection transmission. Strict prevention of infection and health control measures will help to prevent spread of infection and reduce disease incidence.

The FAST-STEMI Network in Biella From 2013 to 2019: Impact of the Delocalization of the Hospital Facilities on Ischemia Time and In-hospital Outcomes.

The optimization of the strategies for myocardial revascularization has improved the outcomes of patients with ST-segment elevation myocardial infarction. In Piedmont, the FAST-STEMI regional network was created for improving the management and transportation of ST-segment elevation (STEMI) patients to primary percutaneous coronary intervention facilities, reducing the time to reperfusion. Within this network, the Hospital of Biella was delocalized in December 2014 to a new suburban structure designed for an easier access, which might have shortened the duration of patients' transportation and ischemia, with potential positive prognostic effects. The aim of the present study was to define the impact of the decentralization of the hospital structure on the time to reperfusion and in-hospital outcomes among STEMI patients admitted to the Hospital of Biella. We included STEMI patients admitted to our urban hospital between 2013 and 2019 and included in the FAST-STEMI database. The primary endpoint was the duration of ischemia, defined as pain to balloon (PTB). The primary outcome endpoint (PE) was in-hospital mortality. We included 276 consecutive patients with STEMI undergoing primary percutaneous coronary intervention between 2016 and 2019 in the new hospital facility, which were compared with 170 patients treated between 2013 and June 2014 in the prior structure. Patients' characteristics included a mean age of 67.5 ± 12.5 years, 72.1% males and 18.7% patients with diabetes. In the new facility, the median PTB was 188 minutes [interquartile range: 125-340 min], reduced as compared with the period 2013-2014 [215 (128.5-352 min), P = 0.002]. The median in-hospital stay was also shorter (P = 0.004), whereas a nonsignificant improvement was noted for ejection fraction (EF) at discharge (P = 0.14). A linear relationship was demonstrated between PTB and the EF (r = -0.183, P = 0.003) in patients treated between 2016 and 2019 while not affecting the length of hospitalization or in-hospital outcomes. In fact, in-hospital death occurred in 36 patients, 8% in the new structure versus 7.7% in 2013-2014 [hazard ratio (HR) (95% confidence interval [CI]) = 1.20 (0.59-2.42), P = 0.62]. The independent predictors of mortality were patients' age and EF at discharge (age ≥ 75 y: adjusted HR [95% CI] = 6.75 [1.51-30.1], P = 0.01; EF: adjusted HR [95% CI] = 0.91 [0.88-0.95], P < 0.001). The present study shows that, among the STEMI patients treated in our center, the delocalization of the hospital facilities and the optimization of the FAST-STEMI network reduced the duration of ischemia, with positive effects on left ventricular function at discharge. However, this did not translate into a significant benefit in survival, which was instead conditioned by the aging of the population.

A Dynamic Systems Approach for Detecting and Localizing of Infarct-Related Artery in Acute Myocardial Infarction Using Compressed Paper-Based Electrocardiogram (ECG).

Timely evaluation and reperfusion have improved the myocardial salvage and the subsequent recovery rate of the patients hospitalized with acute myocardial infarction (MI). Long waiting time and time-consuming procedures of in-hospital diagnostic testing severely affect the timeliness. We present a Poincare pattern ensemble-based method with the consideration of multi-correlated non-stationary stochastic system dynamics to localize the infarct-related artery (IRA) in acute MI by fully harnessing information from paper-based Electrocardiogram (ECG). The vectorcardiogram (VCG) diagnostic features extracted from only 2.5-s long paper ECG recordings were used to hierarchically localize the IRA—not mere localization of the infarcted cardiac tissues—in acute MI. Paper ECG records and angiograms of 106 acute MI patients collected at the Heart Artery and Vein Center at Fresno California and the 12-lead ECG signals from the Physionet PTB online database were employed to validate the proposed approach. We reported the overall accuracies of 97.41% for healthy control (HC) vs. MI, 89.41 ± 9.89 for left and right culprit arteries vs. others, 88.2 ± 11.6 for left main arteries vs. right-coronary-ascending (RCA) and 93.67 ± 4.89 for left-anterior-descending (LAD) vs. left-circumflex (LCX). The IRA localization from paper ECG can be used to timely triage the patients with acute coronary syndromes to the percutaneous coronary intervention facilities.

Effect of percutaneous coronary intervention team prenotification based on real time electrocardiogram transmission in interhospital transfer of ST elevation myocardial infarction patients: pilot trial of Preparing Revascularization Effort before Patients' Arrival via Regionalization Engagement protocol.

ObjectivePrompt reperfusion is important for patients with ST elevation myocardial infarction (STEMI). However, patients often require interhospital transfer for percutaneous coronary intervention (PCI) because not all hospitals can provide. The purpose of this study is to reduce the PCI delay using a regionalization protocol in patients with STEMI following transfer from another hospital lacking PCI facility.MethodsWe established a revascularization protocol designated as Preparing Revascularization Effort before Patients’ Arrival via Regionalization Engagement (PREPARE) for the STEMI patients transferred from an outside regional hospital. The protocol included immediate referral acceptance by an emergency physician, real-time electrocardiogram sharing via mobile phone and early activation of the PCI team. We analyzed the differences between the PREPARE and the non-PREPARE groups.ResultsIn the PREPARE group, the median time from the first hospital visit to the ballooning procedure via PCI at the receiving facility (D1-to-B time) was 111.0 (interquartile range 97.0– 130.0) minutes, which was significantly shorter than in the non-PREPARE group 134.0 (interquartile range 115.0–182.0) minutes. The proportion of D1-to-B time within 120 minutes was 30.4% in the group and 60.0% in the PREPARE group, which represents a significant difference (P=0.004). Multivariate logistic regression analysis revealed that patient transfer via PREPARE protocol (odds ratio, 3.399; 95% confidence interval, 1.150–10.050, P=0.027) was related to adequate D1-to-B time. No statistically significant differences were found in the hospital length of stay or major adverse cardiac events within 4 weeks.ConclusionThe PREPARE protocol is an effective strategy to reduce the time to revascularization of the transferred STEMI patients.

Door-in to door-out times in acute ST-segment elevation myocardial infarction in emergency departments of non-interventional hospitals: A cohort study.

In France, one in eight patients with acute ST-segment elevation myocardial infarction (STEMI) is admitted direct to an emergency department (ED) in a hospital without percutaneous coronary intervention (PCI) facilities. Guidelines recommend transfer to a PCI center, with a door-in to door-out (DI-DO) time of ≤30 min. We report DI-DO times and identify the main factors affecting them.RESURCOR is a French Northern Alps registry of patients with STEMI of <12 h duration. We focused on patients admitted direct, without prehospital medical care, to EDs in 19 non-PCI centers from 2012 to 2014. We divided DI-DO time into diagnostic time (ED admission to call for transfer) and logistical time (call for transfer to ED discharge).Among 2007 patients, 240 were admitted direct to EDs in non-PCI centers; 57.9% were treated with primary angioplasty and 32.9% received thrombolysis. Median (interquartile range) DI-DO time was 92.5 (67-143) min, with a diagnostic time of 41 (23-74) min and a logistical time of 47.5 (32-69) min. Five patients (2.1%) had a DI-DO time ≤30 min. Five variables were independently associated with a shorter DI-DO time: local transfer (mobile intensive care unit [MICU] team available at referring ED) (P = .017) or transfer by air ambulance (P = .004); shorter distance from referring ED to PCI center (P < .001); shorter time from symptom onset to ED admission (P = .002); thrombolysis (P = .006); and extended myocardial infarction (P = .007).In view of longer-than-recommended DI-DO times, efforts are required to promote urgent local transfer and use of thrombolysis.