Cardiology Letters 2016, 25(5):369-375
Time delay due to health care system and impact of the delay on the short term prognosis of patients with STEMI. A single Cardiocentre experience analysis
- Kardiocentra, Kardiologická klinika FNsP a FZO PU Prešov, Slovenská republika
Aim: To assess the impact to their short-term prognosis of the system time delay to primary percutaneous coronary intervention (pPCI) in patients with STEMI.
Methods: Retrospective analysis of documentation of 340 patients with STEMI and primary PCI in the Prešov Cardiocentre in 2014. Short-term prognosis in patients was studied in three indicators: in-hospital mortality, in-hospital cardiac decompensation and systolic left ventricular function judged by echocardiography during hospitalisation. Chí-quadrat tests (χ2) and Fisher exact test, analyses of variance or Mann-Whitneyho U test were calculated to test association between variables.
Results: According to the latest guidelines laid down by the European Society of Cardiology (ESC) and by the Slovak Society of Cardiology (SKS), the system delay (refers to time delay from first medical contact to primary PCI) should be less than 120 minutes. A longer system delay had significant negative impact on short-term prognosis of patients including their in-hospital mortality (3.9% vs 10%, p=0.028) and in-hospital signs of acute heart failure (21.3% vs 39.1%, p=0.001). The impact of longer system delay on left ventricular systolic function was statistically not significant. The time delay in cardiocentre was acceptable since the median of door-to-balloon (D2B) interval was only 25 minutes (±13.4). There was no significant difference in short-term prognosis between study groups with D2B within 30 minutes in comparison to the group with D2B over 30 minutes as to mortality, heart failure and ejection fraction.
Conclusion: Longer system delay for primary PCI (over 120 minutes) has a significant negative impact on short-term prognosis patients including their in-hospital mortality and in-hospital appearance of acute heart failure. The most important subperiod responsible for time delay was the "FMC-to-door" interval. Tab. 2, Fig. 4, Ref. 13, Online full text (Free, PDF) www.cardiology.sk.
Keywords: ST-segment elevation myocardial infarction; primary PCI; time delay; mortality; heart failure; ejection fraction
Published: May 1, 2016 Show citation
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