Assessment of distance to primary percutaneous coronary intervention centres in ST-segment elevation myocardial
João Borges-Rosa1, Manuel Oliveira-Santos1,2, Marco Simões3
1Cardiology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
Insights
Timely treatment for ST-segment elevation myocardial infarction (STEMI) is crucial. Process mining revealed significant delays in reperfusion therapy in Portugal's "Centro" region, highlighting the need for a new percutaneous coronary intervention (PCI) center.
Area of Science:
- Cardiology
- Health Services Research
- Data Science
Background:
- ST-segment elevation myocardial infarction (STEMI) requires prompt reperfusion therapy.
- Treatment delays in STEMI significantly impact patient outcomes.
- Geographical disparities in access to percutaneous coronary intervention (PCI) can affect treatment timeliness.
Purpose of the Study:
- To analyze time delays in reperfusion therapy for STEMI patients in Portugal.
- To identify regional variations in treatment pathways using process mining.
- To inform strategies for improving STEMI care in the "Centro" region.
Main Methods:
- Retrospective observational analysis of STEMI patients from the Portuguese Registry of Acute Coronary Syndromes.
- Application of process mining methodology to national and regional patient flow data.
- Inclusion of data on symptom onset location, reperfusion strategy, and in-hospital mortality.
Main Results:
- Analysis of 8956 STEMI patients revealed that while most received primary PCI, the "Centro" region experienced the longest delays.
- Regional analysis within "Centro" showed significant variations, with "Guarda" and "Castelo Branco" districts having longer diagnosis-to-reperfusion times than "Coimbra".
- In-hospital mortality was higher for patients who did not receive reperfusion therapy compared to those treated with PCI or fibrinolysis.
Conclusions:
- Process mining effectively visualizes and identifies inefficiencies in STEMI treatment pathways.
- A new PCI center in the "Centro" region is essential to reduce delays and improve timely first-line treatment.
- Addressing geographical and regional disparities is critical for optimizing STEMI care outcomes.
Objectives:
In ST-segment elevation myocardial infarction (STEMI), time delay between symptom onset and treatment is critical to improve outcome. The expected transport delay between patient location and percutaneous coronary intervention (PCI) centre is paramount for choosing the adequate reperfusion therapy. The "Centro" region of Portugal has heterogeneity in PCI assess due to geographical reasons. We aimed to explore time delays between regions using process mining tools.
Methods:
Retrospective observational analysis of patients with STEMI from the Portuguese Registry of Acute Coronary Syndromes. We collected information on geographical area of symptom onset, reperfusion option, and in-hospital mortality. We built a national and a regional patient's flow models by using a process mining methodology based on parallel activity-based log inference algorithm.
Results:
Totally, 8956 patients (75% male, 48% from 51 to 70 years) were included in the national model. Most patients (73%) had primary PCI, with the median time between admission and treatment <120 minutes in every region; "Centro" had the longest delay. In the regional model corresponding to the "Centro" region of Portugal divided by districts, only 61% had primary PCI, with "Guarda" (05:04) and "Castelo Branco" (06:50) showing longer delays between diagnosis and reperfusion than "Coimbra" (01:19). For both models, in-hospital mortality was higher for those without reperfusion therapy compared to PCI and fibrinolysis.
Conclusion:
Process mining tools help to understand referencing networks visually, easily highlighting its inefficiencies and potential needs for improvement. A new PCI centre in the "Centro" region is critical to offer timely first-line treatment to their population.
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