Treatment of a cohort of patients with acute myocardial infarction and ST-segment elevation
Jamil da Silva Soares1, Nelson Robson Mendes de Souza, Jair Nogueira Filho
1Hospital Escola Alvaro Alvim, Faculdade de Medicina de Campos, Rio de Janeiro, RJ, Brasil. jamilsoares@uol.com.br
Insights
Many ST-elevation myocardial infarction (STEMI) patients suitable for reperfusion therapy did not receive it. Coronary angiography (CTA) was the predominant treatment, showing low morbidity and mortality in this STEMI cohort.
Area of Science:
- Cardiology
- Interventional Cardiology
- Emergency Medicine
Background:
- ST-elevation myocardial infarction (STEMI) management often falls short of established reperfusion guidelines.
- A significant proportion of STEMI patients do not receive timely thrombolysis or primary percutaneous coronary intervention (PCI).
Purpose of the Study:
- To evaluate the initial and final treatment outcomes in a cohort of STEMI patients.
- To assess the adherence to reperfusion strategies and their associated results in STEMI patients.
Main Methods:
- Retrospective analysis of 158 STEMI patients admitted between 2004 and 2006.
- Evaluation of treatment pathways including coronary angiography (CTA), thrombolysis, and clinical management.
- Assessment of procedural success, complications, and mortality rates.
Main Results:
- 67.7% of STEMI patients arrived within 180 minutes, 81.3% within 360 minutes.
- Coronary angiography (CTA) was performed in 93.7% of patients, with 95.7% angiographic success.
- Despite suitability, approximately 35% of patients did not receive thrombolysis; overall in-hospital mortality was 9.5%.
Conclusions:
- A considerable number of STEMI patients eligible for reperfusion did not receive it.
- Coronary angiography (CTA) emerged as the primary treatment modality with favorable outcomes and low complication rates.
- The study highlights a gap in STEMI treatment adherence and reports a low overall lethality.
Background:
Although thrombolysis and primary CTA are well-established procedures, they are not administered in a large proportion of the patients with STEMI who arrive to the emergency rooms.
Objective:
Describe initial and final the results in a cohort of STEMI patients
Methods:
The study included, from hospital admission to the discharge, 158 patients diagnosed with STEMI, from a total of 351 patients with ACS admitted to hospitals in Campos dos Goytacazes, RJ, Brazil, between 2004 and 2006.
Results:
Of the 158 patients with STEMI, 67.7% arrived to the hospital within 180 minutes, 81.3% within 360 minutes, and 8.4% after twelve hours from the symptoms. Cinecoronariographic studies (148) were performed (93,7%). Lesions of over 70% were observed in 266 artery territories. The initial treatment was CTA in 41 (26%), thrombolytics in 50 (32%), 80% of success. Clinical treatment in 67 (42%). Approximately 35% of the patients should have undergone thrombolysis, but they didn't. During the final treatment, 93 CTAs were performed: 89 with angiographic success (95.7%), bleeding 2 (2.2%), subacute occlusion 2 (2.2%), trunk dissection 1 (1.1%), pseudoaneurism 1 (1.1%). No deaths during angioplasty; during evolution, there were two deaths (2.1%). Twelve patients underwent myocardial revascularization surgery (MRS), while 53 underwent clinical treatment, with 11 deaths (20.7%). Global lethality was 9.5%, considering the three types of treatment.
Conclusions:
Patients were suitable for reperfusion, but one third of them did not have the procedure. Two deaths during evolution. The most predominant treatment was CTA, with low morbidity. Low global lethality.
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