The Busan Regional CardioCerebroVascular Center Project's Experience Over a Decade in the Treatment of ST-segment
Kyunghee Lim1, Hyeyeon Moon2, Jong Sung Park1
1Department of Cardiology, Busan Regional CardioCerebroVascular Center, Dong-A University Hospital, Busan, Korea.
Insights
The Busan Regional CardioCerebroVascular Center project improved ST-segment elevation myocardial infarction (STEMI) treatment times but did not alter survival outcomes. Increased false-positive percutaneous coronary intervention (PCI) team activations were noted.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Public Health Initiatives
Background:
- The Regional CardioCerebroVascular Center (RCCVC) project aimed to enhance acute myocardial infarction and stroke care in non-capital Korean regions.
- This study specifically evaluates the impact of the Busan RCCVC project on ST-segment elevation myocardial infarction (STEMI) treatment.
Purpose of the Study:
- To assess the outcomes and identify challenges of the Busan RCCVC project in managing STEMI.
- To evaluate the effectiveness of the RCCVC initiative in improving patient care for STEMI.
Main Methods:
- Analysis of 1161 STEMI patients undergoing percutaneous coronary intervention (PCI) at the Busan RCCVC.
- Comparison of data from 2007-2019 with a historical cohort to evaluate changes over time.
Main Results:
- Median door-to-balloon time decreased from 86 to 54 minutes; symptom-to-balloon time reduced from 256 to 189 minutes (p<0.001).
- False-positive PCI team activation rate increased significantly from 0.6% to 21.4% (p<0.001).
- One-year rates of cardiovascular death and major adverse cardiac events remained unchanged; many patients still experienced delays or inter-hospital transfers.
Conclusions:
- The Busan RCCVC project successfully reduced reperfusion times for STEMI patients over a decade.
- Despite improved time metrics, survival outcomes for STEMI patients did not significantly change.
- The initiative led to a higher rate of false-positive PCI team activations without a corresponding improvement in mortality or major adverse cardiac events.
Objectives:
The Regional CardioCerebroVascular Center (RCCVC) project was initiated to improve clinical outcomes for patients with acute myocardial infarction or stroke in non-capital areas of Korea. The purpose of this study was to evaluate the outcomes and issues identified by the Busan RCCVC project in the treatment of ST-segment elevation myocardial infarction (STEMI).
Methods:
Among the patients who were registered in the Korean Registry of Acute Myocardial Infarction for the RCCVC project between 2007 and 2019, those who underwent percutaneous coronary intervention (PCI) for STEMI at the Busan RCCVC were selected, and their medical data were compared with a historical cohort.
Results:
In total, 1161 patients were selected for the analysis. Ten years after the implementation of the Busan RCCVC project, the median door-to-balloon time was reduced from 86 (interquartile range [IQR], 64-116) to 54 (IQR, 44-61) minutes, and the median symptom-to-balloon time was reduced from 256 (IQR, 180-407) to 189 (IQR, 118-305) minutes (p<0.001). Inversely, the false-positive PCI team activation rate increased from 0.6% to 21.4% (p<0.001). However, the 1-year cardiovascular death and major adverse cardiac event rates did not change. Even after 10 years, approximately 75% of the patients had a symptom-to-balloon time over 120 minutes, and approximately 50% of the patients underwent inter-hospital transfer for primary PCI.
Conclusions:
A decade after the implementation of the Busan RCCVC project, although time parameters for early reperfusion therapy for STEMI improved, at the cost of an increased false-positive PCI team activation rate, survival outcomes were unchanged.
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