Care Pathway Effect on In-Hospital Care for ST-Elevation Myocardial Infarction

Cardiology ◽  
2018 ◽  
Vol 140 (3) ◽  
pp. 163-174 ◽  
Author(s):  
Daan Aeyels ◽  
Luk Bruyneel ◽  
Peter R. Sinnaeve ◽  
Marc J. Claeys ◽  
Sofie Gevaert ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Secondary Prevention ◽  
Care Pathway ◽  
Coronary Intervention ◽  
St Elevation Myocardial Infarction ◽  
Post Intervention ◽  
St Elevation ◽  
Composite Outcomes ◽  
Prevention Methods ◽  
Pathway Effect

Objectives: To study the care pathway effect on the percentage of patients with ST-elevation myocardial infarction ­(STEMI) receiving timely coronary reperfusion and the percentage of STEMI patients receiving optimal secondary prevention. Methods: A care pathway was implemented by the Collaborative Model for Achieving Breakthrough Improvement. One pre-intervention and 2 post-intervention audits included all adult STEMI patients admitted within 24 h after onset and eligible for reperfusion. Adjusted (hospital random intercepts and controls for transfer and out-of-office admission) differences in composite outcomes were analyzed by a multilevel logistic regression. Results: Significant improvements in intervals between the first medical contact (FMC) to percutaneous coronary intervention (PCI) and between the door to PCI were shown between post-intervention audit II and post-intervention audit I. Secondary prevention significantly deteriorated at post-intervention audit I but improved significantly between both post-intervention audits. Six out of nine outcomes were significantly poorer in the case of transfer. The interval from FMC to PCI was significantly poorer for patients admitted during out-of-office hours. Conclusions: After care pathway implementation, composite outcomes improved for in-hospital STEMI care. Collaborative efforts exploited heterogeneity in performance between hospitals. Iterative and incremental care pathway implementation maximized performance improvement.

scholarly journals Experts’ consensus: pharmaco-invasive therapy for ST‐elevation myocardial infarction along with focus on secondary prevention and cardiac rehabilitation in India

2021 ◽  
Vol 8 (2) ◽  
pp. 325
Author(s):  
Arup Dasbiswas ◽  
Samir Kubba ◽  
Jossy Chacko
Keyword(s):  
Myocardial Infarction ◽  
Secondary Prevention ◽  
Cardiac Rehabilitation ◽  
Coronary Intervention ◽  
St Elevation Myocardial Infarction ◽  
Treatment Protocols ◽  
Invasive Approach ◽  
Coronary Syndrome ◽  
Care Systems ◽  
St Elevation

In India, patients with acute coronary syndrome (ACS) tend to present with higher percentage of ST-elevation myocardial infarction (STEMI). Numerous existing challenges like patient unawareness, lack of structured STEMI care systems, inadequacy of promptly available facilities and unequipped ambulances for patient transport make it difficult to achieve optimal STEMI treatment. Also, due to socio-economic diversities prevailing in India, a large proportion of the entire population has access to only basic primary healthcare and are unable to afford proper medical facilities. Judicious and timely reperfusion strategy has been the mainstay of STEMI management. Even though, percutaneous coronary intervention (PCI) continues to be the gold standard for treating STEMI worldwide, it is not the ideal strategy in many Indian settings, especially in villages and smaller towns/cities. In such scenarios, pharmaco-invasive approach has proved to be a better reperfusion therapeutic strategy for improving treatment outcomes and subsequently reducing morbidity and mortality. The purpose of this consensus article is to highlight the clinical perspectives of Indian cardiologists at identifying and addressing the need gaps currently existing in India for optimization of STEMI treatment approaches. The experts shared their views on the rationale of pharmaco-invasive approach and highlighted the significance of commonly used thrombolytic agents, STEMI treatment protocols, secondary prevention and cardiac rehabilitation.

Optimum Therapies for ST-Elevation Myocardial Infarction Managed with Primary Percutaneous Coronary Intervention

2012 ◽  
Vol 7 (2) ◽  
pp. 81
Author(s):  
Bruce R Brodie ◽  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Primary Percutaneous Coronary Intervention ◽  
Great Majority ◽  
Coronary Intervention ◽  
St Elevation Myocardial Infarction ◽  
Stent Deployment ◽  
Aspiration Thrombectomy ◽  
Percutaneous Coronary ◽  
St Elevation

This article reviews optimum therapies for the management of ST-elevation myocardial infarction (STEMI) with primary percutaneous coronary intervention (PCI). Optimum anti-thrombotic therapy includes aspirin, bivalirudin and the new anti-platelet agents prasugrel or ticagrelor. Stent thrombosis (ST) has been a major concern but can be reduced by achieving optimal stent deployment, use of prasugrel or ticagrelor, selective use of drug-eluting stents (DES) and use of new generation DES. Large thrombus burden is often associated poor outcomes. Patients with moderate to large thrombus should be managed with aspiration thrombectomy and patients with giant thrombus should be treated with glycoprotein IIb/IIIa inhibitors and may require rheolytic thrombectomy. The great majority of STEMI patients presenting at non-PCI hospitals can best be managed with transfer for primary PCI even with substantial delays. A small group of patients who present very early, who are at high clinical risk and have long delays to PCI, may best be treated with a pharmaco-invasive strategy.

Risk factors of coronary microvascular obstruction (Preprint)

2020 ◽  
Author(s):  
Yong Li ◽  
Shuzheng Lyu
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Logistic Regression ◽  
Microvascular Obstruction ◽  
Coronary Intervention ◽  
St Elevation Myocardial Infarction ◽  
Neutrophil Percentage ◽  
Percutaneous Coronary ◽  
St Elevation

BACKGROUND Coronary microvascular obstruction /no-reflow(CMVO/NR) is a predictor of long-term mortality in survivors of ST elevation myocardial infarction (STEMI) underwent primary percutaneous coronary intervention (PPCI). OBJECTIVE To identify risk factors of CMVO/NR. METHODS Totally 2384 STEMI patients treated with PPCI were divided into two groups according to thrombolysis in myocardial infarction(TIMI) flow grade:CMVO/NR group(246cases,TIMI 0-2 grade) and control group(2138 cases,TIMI 3 grade). We used univariable and multivariable logistic regression to identify risk factors of CMVO/NR. RESULTS A frequency of CMVO/NR was 10.3%(246/2384). Logistic regression analysis showed that the differences between the two groups in age(unadjusted odds ratios [OR] 1.032; 95% CI, 1.02 to 1.045; adjusted OR 1.032; 95% CI, 1.02 to 1.046 ; P <0.001), periprocedural bradycardia (unadjusted OR 2.357 ; 95% CI, 1.752 to 3.171; adjusted OR1.818; 95% CI, 1.338 to 2.471 ; P <0.001),using thrombus aspirationdevices during operation (unadjusted OR 2.489 ; 95% CI, 1.815 to 3.414; adjusted OR1.835; 95% CI, 1.291 to 2.606 ; P =0.001),neutrophil percentage (unadjusted OR 1.028 ; 95% CI, 1.014 to 1.042; adjusted OR1.022; 95% CI, 1.008 to 1.036 ; P =0.002) , and completely block of culprit vessel (unadjusted OR 2.626; 95% CI, 1.85 to 3.728; adjusted-OR 1.656;95% CI, 1.119 to 2.45; P =0.012) were statistically significant ( P <0. 05). The area under the receiver operating characteristic curve was 0.6896 . CONCLUSIONS Age , periprocedural bradycardia, using thrombus aspirationdevices during operation, neutrophil percentage ,and completely block of culprit vessel may be independent risk factors for predicting CMVO/NR. We registered this study with WHO International Clinical Trials Registry Platform (ICTRP) (registration number: ChiCTR1900023213; registered date: 16 May 2019).http://www.chictr.org.cn/edit.aspx?pid=39057&htm=4. Key Words: Coronary disease ST elevation myocardial infarction No-reflow phenomenon Percutaneous coronary intervention

Regional variation in appropriate care for ST-elevation myocardial infarction in Finland

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
E Reissell ◽  
S Lumme ◽  
M Satokangas ◽  
K Manderbacka
Keyword(s):  
Myocardial Infarction ◽  
Regional Variation ◽  
Regional Differences ◽  
Coronary Intervention ◽  
Register Data ◽  
St Elevation Myocardial Infarction ◽  
Academic Affiliation ◽  
Episode Of Care ◽  
Appropriate Care ◽  
St Elevation

Abstract Background Timely primary percutaneous coronary intervention (PCI) is currently the treatment of choice for ST-elevation myocardial infarction (STEMI). Although cardiac units were established in all central hospitals in late 1990s for sparsely populated Finland, studies have shown that regional variation has increased. Additionally, the dense Finnish hospital network includes non-cardiac facilities where patients may be inappropriately admitted and then transferred for PCI. We aim to investigate the current regional differences in receiving timely PCI, determinants of these variations and the effect of hospital transfers. Methods Finnish Hospital Discharge Register data on PCIs for STEMI patients in 2015-17 were linked to register data on socio-demographics. In these preliminary analyses we used logistic regression modelling. Results Our results suggest that there were significant regional differences both for timely PCI in STEMI patients and in the probability of hospital transfers during an episode of care. The regional odds ratios (OR) for receiving PCI on time varied from 0.41 (95% confidence interval 0.33-0.52) to 2.73 (2.09-3.57) compared with the capital region when controlling for age, gender and hospital transfers. The ORs for being transferred during an episode of care varied from 0.26 (0.15-0.44) to 16.6 (11.6-23.6). Patients not transferred were more likely to receive PCI (OR 1.89 (1.67-2.15)). Men received PCI on time more often (OR 1.31 (1.18-1.46)) and women were more likely to be transferred (OR 1.29 (1.15-1.45)). Conclusions The probability for receiving PCI on time was related to the size of the hospital's population base and academic affiliation and inversely to transfers between hospitals. Hospital transfers during care episode and atypical symptoms often seen in women may cause critical delays for PCI. Other determinants for variation of timely PCI and its effects on equity will be analysed using multilevel modelling. Key messages Appropriate care for STEMI varies across regions and reflects inept practices in provider network. These findings are more pronounced in women showing persisting gender-related inequity.

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