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IntroductionThe management of Acute Coronary Syndrome (ACS) aims to minimize myocardial damage, preserve myocardial function, and prevent complications.Initial ManagementInpatient management involves continuous cardiac monitoring, preferably in an ICU, focusing on blood pressure, serum sodium, potassium, and creatinine levels, and urine output. Ongoing pharmacologic management is crucial for stabilizing the patient.Supplemental Oxygen: Administer supplemental oxygen if oxygen saturation is...
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Interprofessional care for coronary artery disease includes pharmacological therapy and revascularization procedures.Pharmacological therapy for Coronary Artery Disease (CAD) aims to manage symptoms, prevent complications, and improve patient outcomes through various classes of medications:Antiplatelet Agents:Aspirin and Clopidogrel: These medications inhibit platelet aggregation, preventing blood clots, which is crucial for avoiding heart attacks and strokes. Doctors often prescribe these...
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24/7 Primary Percutaneous Coronary Intervention as a National Program.

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Timely treatment for ST-elevation myocardial infarction (STEMI) is crucial. This study found that 24/7 primary percutaneous coronary intervention (PCI) in Iran achieved acceptable door-to-device times, though improvements are needed for certain patient groups.

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Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Public Health

Background:

  • Early revascularization is critical for ST-elevation myocardial infarction (STEMI) patient outcomes.
  • A 24/7 primary percutaneous coronary intervention (PCI) system requires coordinated pre-hospital care and experienced medical teams.

Purpose of the Study:

  • To evaluate the quality of care and patient management within Iran's national 24/7 STEMI program.
  • To assess the temporal trends in healthcare services provided for STEMI patients undergoing primary PCI.

Main Methods:

  • Cross-sectional study analyzing data from 11,563 STEMI patients.
  • Data collected from 31 PCI-capable hospitals participating in the national 24/7 STEMI management program (September 2015 - August 2017).
  • Evaluation of door-to-device times and patient demographics.

Main Results:

  • The median door-to-device time was 64 minutes, with 68% of patients achieving the guideline-recommended ≤90 minutes.
  • No significant difference in door-to-device times was observed between general and heart hospitals.
  • Older patients, females, and those with non-left anterior descending culprit lesions experienced longer door-to-device times.

Conclusions:

  • Iran's national 24/7 STEMI program demonstrates acceptable door-to-device times, aligning with current guidelines.
  • Further efforts are required to optimize door-to-device times, particularly for specific patient demographics.
  • This study represents the first national initiative in Iran to standardize STEMI management using guideline-driven protocols.