Proportion Of ST-segment Elevation Myocardial Infarction Patients Research Articles

Indirect impact of Covid-19 on hospital care pathways in Italy

Earlier in 2020, seven Italian regions, which cover 62% of the Italian population, set up the Mimico-19 network to monitor the side effects of the restrictive measures against Covid-19 on volumes and quality of care. To this aim, we retrospectively analysed hospital discharges data, computing twelve indicators of volume and performance in three clinical areas: cardiology, oncology, and orthopaedics. Weekly indicators for the period January–July 2020 were compared with the corresponding average for 2018–2019; comparisons were performed within 3 sub-periods: pre-lockdown, lockdown, and post-lockdown. The weekly trend of hospitalisations for ST-segment elevation myocardial infarction (STEMI) showed a 40% reduction, but the proportion of STEMI patients with a primary PTCA did not significantly change from previous years. Malignant neoplasms surgery volumes differed substantially by site, with a limited reduction for lung cancer (< 20%) and greater declines (30–40%) for breast and prostate cancers. The percentage of timely surgery for femoral neck in the elderly remained constantly higher than the previous 2 years whereas hip and knee replacements fell dramatically. Hospitalisations have generally decreased, but the capacity of a timely and effective response in time-dependent pathways of care was not jeopardized throughout the period. General trends did not show important differences across regions, regardless of the different burden of Covid-19. Preventive and primary care services should adopt a pro-active approach, moving towards the identification of at-risk conditions that were neglected during the pandemic and timely addressing patients to the secondary care system.

Abstract 14178: Characteristics and Outcomes of Young ST Segment Elevation Myocardial Infarction Patients Undergoing Primary Percutaneous Intervention

Introduction: ST-segment elevation myocardial infarction (STEMI) is associated with significant morbidity and mortality leading to loss of productivity and productive life years, especially in younger patients. Understanding the characteristics of younger patients with STEMI and their outcomes could help focus public health efforts in STEMI prevention within a population. Aim: This study aims to compare the characteristics and outcomes of younger versus older patients with STEMI undergoing primary percutaneous intervention (PPCI). Methods: Data from the Coronary Care Unit database of the National University Hospital between July 2015 to June 2019 was reviewed. Patients were divided into Young (&lt;50 years old) or Old (≥50 years old) groups. Results: Of the 1818 consecutive patients with STEMI and underwent PPCI, 465 (25.6%) were Young patients with mean age 43±4.9 years old as compared to Old patients with mean age 63.2±9.4 years old. Young patients were more likely to be male (94% vs. 85%, p&lt;0.0001), current smokers (61.1% vs. 42.6%, p&lt;0.0001), of Indian ethnicity (32% vs. 16.3%, p&lt;0.0001), and had family history of myocardial infarction (MI) (18.1% vs. 9.5%, p&lt;0.0001). Compared to Old patients, Young patients had better post-MI left ventricular ejection fraction (49.5±10.7 vs. 47.8±11.6, p=0.007) with fewer of them suffered from cardiogenic shock (7.1% vs. 13.2%, p&lt;0.0001), and had lower mortality at one year (3.4% vs. 10.4%, p&lt;0.0001). Although diabetes, hypertension and hyperlipidemia was less common among the Young patients when compared to the Old, the prevalence was high in the range of 28 to 38% (Table 1). Conclusions: A sizable proportion of STEMI patients are younger than 50 years old. The risk profile of these younger patients can be attributed to constitutional factors and smoking but other cardiovascular risk factors are also prevalent among them. Although mortality is lower among the younger than the older patients, it is not negligible.

Current Trends for ST-segment Elevation Myocardial Infarction during the Past 5 Years in Rural Areas of China's Liaoning Province: A Multicenter Study.

Background:Since 2010, two versions of National Guidelines aimed at promoting the management of ST-segment elevation myocardial infarction (STEMI) have been formulated by the Chinese Society of Cardiology. However, little is known about the changes in clinical characteristics, management, and in-hospital outcomes in rural areas.Methods:In the present multicenter, cross-sectional study, participants were enrolled from rural hospitals located in Liaoning province in Northeast China, during two different periods (from June 2009 to June 2010 and from January 2015 to December 2015). Data collection was conducted using a standardized questionnaire. In total, 607 and 637 STEMI patients were recruited in the 2010 and 2015 cohorts, respectively.Results:STEMI patients in rural hospitals were older in the second group (63 years vs. 65 years, P = 0.039). We found increases in the prevalence of hypertension, prior percutaneous coronary intervention (PCI), and prior stroke. Over the past 5 years, the cost during hospitalization almost doubled. The proportion of STEMI patients who underwent emergency reperfusion had significantly increased from 42.34% to 54.47% (P < 0.0001). Concurrently, the proportion of primary PCI increased from 3.62% to 10.52% (P < 0.0001). The past 5 years have also seen marked increases in the use of guideline-recommended drugs and clinical examinations. However, in-hospital mortality and major adverse cardiac events did not significantly change over time (13.01% vs. 10.20%, P = 0.121; 13.34% vs. 13.66%, P = 0.872).Conclusions:Despite the great progress that has been made in guideline-recommended therapies, in-hospital outcomes among rural STEMI patients have not significantly improved. Therefore, there is still substantial room for improvement in the quality of care.

LEFT VENTRICULAR SYSTOLIC RECOVERY AFTER ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION: EFFECT OF GUIDELINE-BASED THERAPY

Background: Reduced left ventricular ejection fraction (LVEF) is associated with poor prognosis after ST-segment elevation myocardial infarction (STEMI). Little is known about the proportion of STEMI patients with reduced LVEF within 48 hours of admission (baseline) who exhibit LVEF recovery under

Primary versus secondary transport of STEMI patients: impact on transport times and mortality

Background: The door-balloon time (DBT) is linked to morbidity and mortality of patients with ST segment elevation myocardial infarction (STEMI). Despite preferable direct transport to catheterization laboratory (PT), still significant proportion of STEMI patients is transported via non-PCI regional hospitals or Coronary Care Units (ST) prior to percutaneous coronary intervention (PCI). This study assessed to what extent PT vs ST affects the DBT and mortality. Methods: Our region with 600 000 inhabitants uses well elaborated 24hours/365 days system of immediate transport of all patients with STEMI lasting less than 12 hours to referral catheterization laboratories in the tertiary University Hospital Cardiac Center for more than 15 years. We prospectively recorded DBT of 677 consecutive patients with STEMI, treated by PCI in the years 2008-2009. Consequent follow-up was obtained in all patients. Results: Median of DBT was 34±15.9 mins for PT patients (n=354) and 100±28.8 mins for patients with ST (n=323) (p<0.005). One-month mortality was 4% vs 9.5% (p=0.002) in the PT vs ST group, respectively. One-year mortality in the PT and ST groups was 7.3 vs 20.5% (p<0.005), respectively. ![Figure][1] One-year mortality (\***|p<0.05) Conclusion: The admission of patients with STEMI to regional hospitals or Coronary Care Units instead of direct transport to catheterization laboratory significantly prolongs the DBT and increases mortality. [1]: pending:yes