Pharmaco-invasive Strategy in Myocardial Infarction: Descriptive Analysis, Presentation of Ischemic Symptoms and
Henrique Tria Bianco1, Rui Povoa1, Maria Cristina Izar2
1Universidade Federal de São Paulo - Cardiologia, São Paulo, SP - Brasil.
Arquivos Brasileiros De Cardiologia
|December 1, 2022
Summary
Women with ST-segment elevation myocardial infarction (STEMI) experience symptom recognition delays and slower thrombolysis, leading to higher mortality. The Killip-Kimball score effectively predicts risk across diverse clinical presentations.
Area of Science:
- Cardiology
- Emergency Medicine
- Clinical Outcomes Research
Background:
- ST-segment elevation myocardial infarction (STEMI) diagnosis relies on symptoms and ECG, but symptom characterization, especially in women and the elderly, remains unclear.
- Understanding symptom presentation and pre-hospital delays is crucial for optimizing treatment strategies in STEMI patients.
- Subgroup analysis is essential to identify disparities in care and outcomes for vulnerable populations.
Purpose of the Study:
- To analyze the typification of ischemic symptoms in STEMI patients.
- To evaluate temporal metrics, including symptom onset to care demand and emergency room arrival to thrombolysis times.
- To assess in-hospital outcomes and the predictive value of scoring systems in a drug-invasive strategy for STEMI.
Main Methods:
- A study of 2,290 STEMI patients was conducted, categorizing clinical presentations into typical pain, atypical pain, dyspnea, and syncope.
- Key time intervals measured were symptom onset to care demand and emergency unit arrival to thrombolysis.
- Regression models estimated odds ratios (ORs) with 95% confidence intervals (CIs), and ROC curves analyzed mortality predictors.
Main Results:
- Women presented with more atypical symptoms, longer symptom-to-care delays, and delayed fibrinolysis. Overall hospital mortality was 5.6%.
- The Killip-Kimball classification demonstrated good predictive accuracy for mortality (AUC: 0.77 for class ≥II).
- Higher mortality rates were associated with specific subgroups: women (OR 2.06), chronic renal failure (OR 3.39), elderly (OR 2.09), diabetics (OR 1.55), obese (OR 1.56), and prior stroke (OR 2.01).
Conclusions:
- Significant disparities persist for women with STEMI, including delayed symptom recognition and thrombolysis, despite comparable mortality to other high-risk groups.
- The Killip-Kimball score is a valuable tool for predicting mortality in STEMI patients, irrespective of their initial clinical presentation.
- Addressing delays in care for women and other high-risk subgroups is critical for improving STEMI outcomes.
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