Cor Vasa 2018, 60(3):e239-e245 | DOI: 10.1016/j.crvasa.2017.07.007

Analysis of time intervals related to STEMI management in 2008-2016

Lumír Francek^a,*, Ota Hlinomaz^a,b, Ladislav Groch^a,b, Silvie Bělašková^b

^a I. interní kardioangiologická klinika, Lékařská fakulta Masarykovy univerzity a Fakultní nemocnice u sv. Anny v Brně, Brno, Česká republika

^b Mezinárodní centrum klinického výzkumu, Fakultní nemocnice u sv. Anny v Brně, Brno, Česká republika

Introduction: A modern treatment of patients with ST segment elevation myocardial infarction (STEMI) is based on a rapid primary percutaneous coronary intervention with direct recanalization of the affected coronary artery (dPCI). The outcome of the treatment depends largely on the pre-hospital care management, which can reduce the total ischaemic time and subsequently improve patient's outlook.

Aims: The principal aims of this retrospective study were to assess the development of time intervals related to the pre-hospital care and the effect of the mode of transportation to the cathlab (primary vs secondary) on these intervals in patients with acute STEMI treated by primary PCI in 2008, 2010, 2012, 2014 and 2016.

Methods: We have analysed patients with STEMI treated using PCI within 12 h of symptoms onset. In total, 1250 patients were included. To evaluate the development over the last 8 years, uni- and multivariate analyses were used. Categorical variables were analysed using chi-squared tests while continuous variables were analysed using one-way ANOVA and general linear models. The effect of the year and of mode of transportation on time intervals was studied.

Results: The time intervals did not significantly differ among years with the exception of 2014 where the reason of the deviation was however not related to the quality of the pre-hospital care. The 120 min limit from the first medical contact to unblocking the affected artery (FMCTB) was met in more than 80% patients (80.8%), the recommended limit of 90 min in 55.2% of patients. The key factor affecting the total ischaemic time was however the patients' choice of the mode of transportation - in patients who opted for the primary route of transportation, i.e., called the ambulance, the intervals were significantly shorter (FMCTB on average by 38.2 min and total ischaemic time by 92.9 min). The principal delays were detected in the patients' delay (103 min in patients with primary transportation route, 131 in patients with secondary route) as well as, unfortunately, in the intervals between reporting the patients' problem to the system and ECG-confirmed diagnosis (26 min if the patient calls ambulance vs 52 min if they present at a general practitioner or outpatient clinic) and subsequent transportation to the cathlab (60 min for primary route, 97 for secondary). The latter two should be in particular targeted and we can see a significant room for improvement here.

Conclusion: The time intervals do not vary among individual years (with some exceptions). The route of transportation, which is a patient's choice, on the total ischaemic time is however a crucial and predominant factor affecting the total ischaemic time as well as individual intervals.

Keywords: FMCTB; Logistics; Primary transport; Secondary mode of transportation; STEMI; Total ischaemic time

Received: April 27, 2017; Accepted: July 26, 2017; Published: June 1, 2018  Show citation