P5594ST elevation myocardial infarction network still faster saves still more lives

Abstract

Introduction: Time to reperfusion therapy of patients with ST elevationmyocardial infarction (STEMI) is determinant for prognosis. Despite many efforts in the country, total ischemia time (since the onset of symptoms until reperfusion) little has reduced, especially the time between the first medical contact until reperfusion. Purpose(s): To evaluate the prognostic impact of myocardial revascularization time in patients with STEMI Methods: Retrospective study was conducted encompassing all patients admitted for STEMI in a cardiology service of 1/10/2010 to 31/8/2015 treated with angioplasty. These patients were divided into 5 groups depending on the time elapsed from the onset of symptoms until revascularization time (0-3h; 3-6h; 6-12h; 12-24h; >24h). Medical history of patients, data on admission and therapeutic strategies were evaluated. It was performed univariate and multivariate analysis of mortality and hospitalization rates in follow-up of 1 year. For statistical analysis we used SPSS. Result(s): In the study period were admitted 1478 patients with STEMI: 501 (34,5%) were revascularized with 0-3h of pain, 506 (34,9%) with 3-6h, 207 (14,3%) with 6-12h, 140 (9,5%) with 12-24h and 97 (6,6%) with <24h. There was an association with longer revascularization time: female sex (p<0,01), older age (p<0,01), diabetes mellitus (p=0,01), angina pectoris (p=0,01), chronic kidney disease (p=0,01), pulmonary disease (p=0,04), dementia (p<0,01) and hemorrhage (p=0,03). There was an association with shorter revascularization time: male sex (p<0,01), lower age (p<0,01), smoking (p<0,01), dyslipidemia (p=0,01), myocardial infarction history (p<0,01), coronary angioplasty history (p<0,01), stroke history (p=0,04) and cardiac arrest (p<0,01). The increase in revascularization time led to a greater number of complications including heart failure (p<0,01), atrial fibrillation (p<0,01), mechanical complications (p<0,01), auriculo-ventricular block (p=0,2), use of non-invasive ventilation (p=0,01) and evolution in Killip class Kimball 2 or higher (p<0,01). In groups of 0-3h, 3-6h, 6-12h, 12-24h and >24h in-hospital mortality was respectively of 3,2%, 4,9%, 9,2%, 12,9% and 7,2% (p<0,01); the ejection fraction of the left ventricle (LVEF) was 57,8%, 56,3%, 53,3%, 51,1% and 52,3%; hospitalization rate in 1 year follow-up was 10,7%, 19,4%, 24,1%, 23,5% and 25,4% (p<0,01); mortality rate in 1 year follow-up 6,4%, 5,6%, 12,1%, 8,2% and 12,7% (p=0,02). Conclusion(s): In patients with STEMI: 1. Longer revascularization time had led to a significant increase in myocardial infarction complication, in-hospital mortality and a significant reduction in left ventricular function assessed by LVEF. 2. In 1 year follow-up patients with longer revascularization time had higher hospitalization rate and higher mortality rate. 3. These results reinforce the need for an investment of physicians and health entities to make the STEMI network "still" faster.