1887
Volume 2022, Issue 4
  • ISSN: 1999-7086
  • EISSN: 1999-7094

Abstract

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. 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. 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%, <  0.001). Men developed STEMI at a younger mean age (53.15 ± 12.53 years,  = 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%, <  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 ( <  0.001). 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.

Loading

Article metrics loading...

/content/journals/10.5339/jemtac.2022.25
2022-07-07
2024-03-28
Loading full text...

Full text loading...

/deliver/fulltext/jemtac/2022/4/jemtac.2022.25.html?itemId=/content/journals/10.5339/jemtac.2022.25&mimeType=html&fmt=ahah

References

  1. Eisen A, Giugliano RP, Braunwald E. Updates on acute coronary syndrome: a review. JAMA Cardiology. 2016; 1:(6):718–30.
    [Google Scholar]
  2. Yiadom MYA. Emergency department treatment of acute coronary syndromes. Emergency Medicine Clinics. 2011; 29:(4):699–710.
    [Google Scholar]
  3. O'Gara PT, Kushner FG, Ascheim DD, Casey DE, Chung MK, De Lemos JA, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Journal of the American College of Cardiology. 2013; 61:(4):e78–e140.
    [Google Scholar]
  4. Zeymer U, Ludman P, Danchin N, Kala P, Laroche C, Sadeghi M, et al. ESC, on behalf of the A.E.E.A.C. S.S. investigators group of the ESC. Reperfusion therapies and in-hospital outcomes for ST-elevation myocardial infarction in Europe: the ACVC-EAPCI EORP STEMI Registry of the European Society of Cardiology. European Heart Journal. 2021; 42:(44):4536–49.
    [Google Scholar]
  5. Yiadom MYA, Baugh CW, McWade CM, Liu X, Song KJ, Patterson BW, et al. (2017). Performance of emergency department screening criteria for an early ECG to identify ST-segment elevation myocardial infarction. Journal of the American Heart Association. 2017; 6:(3):e003528.
    [Google Scholar]
  6. Cucherat M, Bonnefoy E, Tremeau G. Primary angioplasty versus intravenous thrombolysis for acute myocardial infarction. Cochrane Database Syst Rev. 2003;:(3):CD001560. doi: 10.1002/14651858.CD001560.
    [Google Scholar]
  7. Windecker S, Kolh P, Alfonso F, Collet JP, Cremer J, Falk V, et al. 2014 ESC/EACTS guidelines on myocardial revascularization. EuroIntervention. 2015; 10:(9):1024–94.
    [Google Scholar]
  8. Ward MJ, Vogus TJ, Bonnet K, Moser K, Schlundt D, Kripalani S. Breaking down walls: a qualitative evaluation of perceived emergency department delays for patients transferred with ST-elevation myocardial infarction. BMC Emergency Medicine. 2020 Dec; 20:(1):60.
    [Google Scholar]
  9. Granger CB, Bates ER, Jollis JG, Antman EM, Nichol G, O'Connor RE, et al. Improving care of STEMI in the United States 2008 to 2012: a report from the American Heart Association Mission: Lifeline program. Journal of the American Heart Association. 2019; 8:(1):e008096.
    [Google Scholar]
  10. Ruiz AC, Utset JM, Solé AA. Predictors of late reperfusion in STEMI patients undergoing primary angioplasty. Impact of the place of first medical contact. Revista Española de Cardiología (English Edition). 2017; 70:(3):162–9.
    [Google Scholar]
  11. Dharma S. Comparison of real-life systems of care for ST-segment elevation myocardial infarction. Global Heart. 2022; 15:(1).
    [Google Scholar]
  12. AlHabib KF, Sulaiman K, Al-Motarreb A, Almahmeed W, Asaad N, Amin H, et al. Baseline characteristics, management practices, and long-term outcomes of Middle Eastern patients in the Second Gulf Registry of Acute Coronary Events (Gulf RACE-2). Annals of Saudi Medicine. 2012; 32:(1):9–18.
    [Google Scholar]
  13. El-Menyar A, Zubaid M, AlMahmeed W, Sulaiman K, AlNabti A, Singh R, Al Suwaidi J. Killip classification in patients with acute coronary syndrome: insight from a multicenter registry. The American Journal of Emergency Medicine. 2012 Jan 1; 30:(1):97–103.
    [Google Scholar]
  14. Antman EM, Cohen M, Bernink PJ, McCabe CH, Horacek T, Papuchis G, Mautner B, Corbalan R, Radley D, Braunwald E. The TIMI risk score for unstable angina/non–ST elevation MI: a method for prognostication and therapeutic decision making. JAMA. 2000 Aug 16; 284:(7):835–42.
    [Google Scholar]
  15. Granger CB, Goldberg RJ, Dabbous O, Pieper KS, Eagle KA, Cannon CP, et al. Predictors of hospital mortality in the global registry of acute coronary events. Archives of Internal Medicine. 2003 Oct 27; 163:(19):2345–53.
    [Google Scholar]
  16. Sinnaeve PR, Van de Werf F. Transporting STEMI patients for primary PCI: a long and winding road paved with good intentions? European Heart Journal. 2016; 37:(13): 1041–3.
    [Google Scholar]
  17. AlHabib KF, Sulaiman K, Al Suwaidi J, Almahmeed W, Alsheikh-Ali AA, Amin H, et al. Patient and system-related delays of emergency medical services use in acute ST-elevation myocardial infarction: results from the Third Gulf Registry of Acute Coronary Events (Gulf RACE-3Ps). PloS One. 2016 Jan 25; 11:(1):e0147385.
    [Google Scholar]
  18. Ellahham S. Diabetes and its associated cardiovascular complications in the Arabian Gulf: challenges and opportunities. J Clin Exp Cardiol. 2020;:11:1–5.
    [Google Scholar]
  19. Aljefree N, Ahmed F. Prevalence of cardiovascular disease and associated risk factors among adult population in the Gulf region: a systematic review. Advances in Public Health. 2015 Jan 27;2015.
    [Google Scholar]
  20. El-Menyar A, Zubaid M, Sulaiman K, AlMahmeed W, Singh R, Alsheikh-Ali AA, Al Suwaidi J, Gulf Registry of Acute Coronary Events (Gulf Race) Investigators. Atypical presentation of acute coronary syndrome: a significant independent predictor of in-hospital mortality. Journal of Cardiology. 2011 Mar 1; 57:(2):165–71.
    [Google Scholar]
  21. Al-Mallah MH, Alsheikh-Ali AA, Almahmeed W, Sulaiman K, Al Suwaidi J, Ridha M, Al-Motarreb A, Alenezi F, Zubaid M. Missed opportunities in the management of ST-segment elevation myocardial infarction in the Arab Middle East: patient and physician impediments. Clinical Cardiology. 2010 Sep; 33:(9):565–71.
    [Google Scholar]
  22. Fares S, Zubaid M, Al-Mahmeed W, Ciottone G, Sayah A, Al Suwaidi J, et al. (2011). Utilization of emergency medical services by patients with acute coronary syndromes in the Arab Gulf States. The Journal of Emergency Medicine. 2011; 41:(3):310–6.
    [Google Scholar]
  23. Al Suwaidi J. Acute coronary syndrome in the Middle East: The importance of registries for quality assessment and plans for improvement. Global Cardiology Science and Practice. 2013 Mar 31; 2013:(1):2.
    [Google Scholar]
  24. Keats A, Moran D, Rothwell S, Woodcock T, Williams T, Rawat N. A quality improvement project to reduce door-to-electrocardiogram time: A multicenter study. Journal of the Saudi Heart Association. 2018; Jul 1; 30:(3):180–7.
    [Google Scholar]
  25. Lee CK, Meng SW, Lee MH, Chen HC, Wang CL, Wang HN, et al. The impact of door-to-electrocardiogram time on door-to-balloon time after achieving the guideline-recommended target rate. PloS One. 2019; Sep 9; 14:(9):e0222019.
    [Google Scholar]
  26. Wang TY, Nallamothu BK, Krumholz HM, Li S, Roe MT, Jollis JG, et al. Association of door-in to door-out time with reperfusion delays and outcomes among patients transferred for primary percutaneous coronary intervention. JAMA. 2011; Jun 22; 305:(24):2540–7.
    [Google Scholar]
  27. Clot S, Rocher T, Morvan C, Cardine M, Lotfi M, Turk J, et al. Door-in to door-out times in acute ST-segment elevation myocardial infarction in emergency departments of non-interventional hospitals: A cohort study. Medicine. 2020 Jun 5; 99:(23).
    [Google Scholar]
  28. Shi O, Khan AM, Rezai MR, Jackevicius CA, Cox J, Atzema CL, et al. Factors associated with door-in to door-out delays among ST-segment elevation myocardial infarction (STEMI) patients transferred for primary percutaneous coronary intervention: a population-based cohort study in Ontario, Canada. BMC Cardiovascular Disorders. 2018 Dec; 18:(1):1–9.
    [Google Scholar]
  29. Granger CB, Bates ER, Jollis JG, Antman EM, Nichol G, O'Connor RE, et al. Improving care of STEMI in the United States 2008 to 2012: a report from the American Heart Association Mission: Lifeline program. Journal of the American Heart Association. 2019; Jan 8; 8:(1):e008096.
    [Google Scholar]
  30. Dakota I, Dharma S, Andriantoro H, Firdaus I, Danny SS, Zamroni D, Radi B. “Door-in to door-out” delay in patients with acute ST-segment elevation myocardial infarction transferred for primary percutaneous coronary intervention in a metropolitan STEMI network of a developing country. International Journal of Angiology. 2020 Mar; 29:(1):27–32.
    [Google Scholar]
  31. Miedema MD, Newell MC, Duval S, Garberich RF, Handran CB, Larson DM, et al. Causes of delay and associated mortality in patients transferred with ST-segment–elevation myocardial infarction. Circulation. 2011; Oct 11; 124:(15):1636–44.
    [Google Scholar]
  32. Abuzeyad FH, Al Qasim G, Alqasem L, Al Farras MI. Evolution of emergency medical services in the Kingdom of Bahrain. International Journal of Emergency Medicine. 2020 Dec; 13:(1):1–8.
    [Google Scholar]
  33. Ward M, Kripalani S, Storrow A, Liu D, Speroff T, Matheny M, et al. Timeliness of inter-facility transfer for emergency department patients with ST-elevation myocardial infarction. Academic Journal of Emergency Medicine. 2015 May; 33:(3):423–9.
    [Google Scholar]
  34. Ward MJ, Vogus TJ, Munoz D, Collins SP, Moser K, Jenkins CA, et al. Examining the timeliness of ST-elevation myocardial infarction transfers. Western Journal of Emergency Medicine. 2021 Mar; 22:(2):319.
    [Google Scholar]
  35. Jorolemon MR, Plis L, Sigona K, Allain M, Pikarsky R, Surprenant S, et al. Transmission of prehospital 12-lead ECGs significantly reduces time of emergency department arrival to arrival in the angiography suite and door-to-balloon time in patients with a STEMI. Circulation. 2012; 126: (suppl 21).
    [Google Scholar]
  36. Kawecki D, Gierlotka M, Morawiec B, Hawranek M, Tajstra M, Skrzypek M, et al. Direct admission versus interhospital transfer for primary percutaneous coronary intervention in ST-segment elevation myocardial infarction. JACC: Cardiovascular Interventions. 2017; Mar 13; 10:(5):438–47.
    [Google Scholar]
  37. Scott IA. Why we need a national registry in interventional cardiology. Medical Journal of Australia. 2008 Aug; 189:(4):223–7.
    [Google Scholar]
http://instance.metastore.ingenta.com/content/journals/10.5339/jemtac.2022.25
Loading
/content/journals/10.5339/jemtac.2022.25
Loading

Data & Media loading...

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error