Impact Prognostic of Delayed Reperfusion Time in Patients with Stemi of ≤24 Hours Treated in the Emergency Department of a General Hospital
Abstract:
Objective: to analyze the prognostic of patients with STEMI treated in the Emergency Department (ED) and the impact prognostic of the delayed reperfusion time.
Design: Retrospective observational cohort study of patients included in the Illes Balears infarction code registry (CI-IB). 2008-2018.
Patients: Acute coronary syndrome with ST elevation of ≤ 24 h. Main Variables of Interest: Age, sex, cardiovascular risk factors, site of AMI, time delays, reperfusion therapy with fibrinolysis and primary angioplasty (PA). Cardiovascular Event (CE) was defined the combined variable: Killip class progression, malignant arrhythmias, Re-infarction, cerebrovascular disease and mortality.
Results: 605 patients were analyzed. The reperfusion treatment was 83,1% (80,8% with PA). 19% presented some CE. Hospital and monthly mortality were 6.8% and 7.8% respectively. The main differences between patients with and without CE were: age (66 vs 59 years); Chronic obstructive pulmonary disease (COPD); previous infarction; anterior location; Door-To-Needle Time and FPC-PA time. The risk factors of CE were: age, COPD, anterior location, fibrinolysis and patients without reperfusion treatment. In the group with PA, the risk of mortality was higher in COPD (p=0.012), Symptom start –FPC time with (p = 0,084) and FPC-PA time > 90 minutes (p= 0.107). FCM-AP> 90 minutes had a higher mortality (10 vs 4.4%; HR 1,79; IC 95% 1,15-2,78; log-rank: p=0,013).
Conclusion: In our cohort, most patients received reperfusion treatment and were performed within the recommended time. In ED, the patients with a FPC-PA time longer than recommended in the guidelines and COPD had higher CE y mortality.
