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[Evolution of the interventional reperfusion strategy and reperfusion times in acute ST-segment elevation myocardial
S Azzaz1, C Charbonnel1, B Ajlani1
1Unité de soins intensifs cardiologiques et cardiologie interventionnelle, service de cardiologie, hôpital André-Mignot, 177, rue de Versailles, 78157 Le Chesnay cedex, France.
Insights
Achieving recommended reperfusion times for ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (pPCI) improved significantly between 2007 and 2012. This enhancement in STEMI treatment times was linked to better inter-team coordination and updated protocols.
Area of Science:
- Cardiology
- Interventional Cardiology
- Emergency Medicine
Background:
- Primary percutaneous coronary intervention (pPCI) is the standard treatment for ST-segment elevation myocardial infarction (STEMI).
- Recommended reperfusion times, including first medical contact-to-balloon (M2B) and door-to-balloon (D2B), are frequently not met in STEMI patients.
- Less than 50% of STEMI patients achieve guideline-adherent reperfusion times.
Purpose of the Study:
- To compare reperfusion strategies and times in STEMI patients undergoing pPCI.
- To evaluate changes in STEMI treatment times between 2007 and 2012.
Main Methods:
- Retrospective analysis of 182 STEMI patients treated with pPCI within 12 hours of symptom onset.
- Comparison of procedural characteristics and reperfusion times between two cohorts: 2007-2008 (Period 1) and 2012 (Period 2).
- Non-parametric statistical tests were used for comparison.
Main Results:
- The median M2B time decreased by 26% from 135 minutes in 2007 to 100 minutes in 2012 (P<0.001).
- The median D2B time also significantly decreased from 51 minutes to 44 minutes (P<0.01).
- Increased use of radial access, thromboaspiration, drug-eluting stents, and reduced incidence of cardiogenic shock were observed in 2012.
Conclusions:
- Reperfusion times (D2B and M2B) significantly improved between 2007 and 2012, with over 60% of patients meeting recommended goals.
- Improved coordination between emergency medical services and interventional cardiology teams likely contributed to the reduced times.
- Implementation of 24/7 paramedic presence in catheterization labs, as per French regulation, may have enhanced pPCI efficiency.
Background:
In patients with acute ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (pPCI), the recommended times (first medical contact-to-balloon (M2B) <120 or <90min, and door-to-balloon (D2B) <45min) are reached in less than 50% of patients.
Purpose:
To compare the interventional reperfusion strategy and reperfusion times between two series of consecutive STEMI patients referred for pPCI within 12hours of symptom onset, in 2007 and 2012.
Methods:
Retrospective study of 182 patients, 87 admitted from January 2007 to March 2008 (period 1), and 95 admitted from January to December 2012 (period 2). The procedural characteristics and the different times between onset of pain and mechanical reperfusion were gathered and compared by non-parametric tests.
Results:
Radial access, thromboaspiration, and drug eluting stents were more frequent, and cardiogenic shock was less common during period 2, compared with the period 1. The median time from first medical contact to balloon (M2B) decreased by 26% (135min, [quartiles: 113-183] in 2007 versus 100 [76-137] in 2012, P<0.001), in relation to the reduction in both prehospital times and time in the catheterization laboratory (D2B: 51 [44-65] and 44min [37-55], respectively, P<0.01).
Conclusions:
The D2B and M2B times significantly decreased in our centre between 2007 and 2012, and reached the recommended values in >60% of the cases. This may be explained by better coordination between emergency medical units and interventional cardiologists, and by the presence of two paramedics in the catheterization laboratory for 24/24 7/7 pPCI since 2010 in France, in accordance with recent national regulation.
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