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.
Insights
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.
Background:
ST-segment elevation myocardial infarction (STEMI) is defined by symptoms accompanied by typical electrocardiogram changes. However, the characterization of ischemic symptoms is unclear, especially in subgroups such as women and the elderly.
Objectives:
To analyze the typification of ischemic symptoms, temporal metrics and observe the occurrence of in-hospital outcomes, in the analysis of predictive scores, in patients with STEMI, in a drug-invasive strategy.
Methods:
Study involving 2,290 patients. Types of predefined clinical presentations: typical pain, atypical pain, dyspnea, syncope. We measured the time between the onset of symptoms and demand for care and the interval between arrival at the medical unit and thrombolysis. Odds-ratios (OR; CI-95%) were estimated in a regression model. ROC curves were constructed for mortality predictors. The adopted significance level (alpha) was 5%.
Results:
Women had a high prevalence of atypical symptoms; longer time between the onset of symptoms and seeking care; delay between arrival at the emergency room and fibrinolysis. Hospital mortality was 5.6%. Risk prediction by Killip-Kimball classification: AUC: [0.77 (0.73-0.81)] in class ≥II. Subgroups studied [OR (CI-95%)]: women [2.06 (1.42-2.99); p=0.01]; chronic renal failure [3.39 (2.13-5.42); p<0.001]; elderly [2.09 (1.37-3.19) p<0.001]; diabetics [1.55 (1.04-2.29); p=0.02]; obese 1.56 [(1.01-2.40); p=0.04]: previous stroke [2.01 (1.02-3.96); p=0.04] correlated with higher mortality rates.
Conclusion:
Despite higher mortality rates in some subgroups, significant disparity persists in women, with delays in symptom recognition and prompt thrombolysis. We highlight the applicability of the Killip-Kimball score in prediction, regardless of the clinical presentation.
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