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Causas de retraso y mortalidad asociada en pacientes transferidos con infarto de miocardio por elevación del segmento

Michael D Miedema¹, Marc C Newell, Sue Duval

¹Minneapolis Heart Institute Foundation, 920 E 28th St, Ste 100, Minneapolis, MN 55407, USA.

|September 21, 2011

Resumen

Los sistemas regionales tienen como objetivo acelerar la atención del infarto de miocardio por elevación del segmento ST. Todavía se producen retrasos en la transferencia del tratamiento, con impactos variables en los resultados del paciente dependiendo de la causa.

Área de la Ciencia:

Cardiología Cardiología.
Medicina de emergencia Medicina de emergencia.
Sistemas de Salud Investigación de Sistemas de Salud

Sus antecedentes:

Los sistemas regionales para el infarto de miocardio por elevación del segmento ST (STEMI) son cruciales para la intervención coronaria percutánea primaria (PCI) oportuna.
Los retrasos del sistema pueden reducir los beneficios de mortalidad de la ICP primaria para los pacientes con STEMI.
Las causas y la importancia clínica de los retrasos en las transferencias interhospitalarias de STEMI no se comprenden bien.

Objetivo del estudio:

Investigar las razones y el impacto clínico de los retrasos en el tratamiento en pacientes transferidos para ICP primaria.
Para analizar los retrasos que se producen en los hospitales de referencia, durante el transporte y en el centro de PCI.

Principales métodos:

Estudio observacional prospectivo de 2034 pacientes transferidos para ICP primaria.
Datos recopilados desde marzo de 2003 hasta diciembre de 2009 dentro de un sistema STEMI regional.
Análisis de los tiempos de tratamiento, los lugares de retraso, las razones del retraso y la mortalidad hospitalaria.

Principales resultados:

A pesar de las transferencias de larga distancia, el 30,4% de los pacientes recibieron tratamiento en 90 minutos y el 65,7% en 120 minutos.
La mayoría de los retrasos se originaron en el hospital de referencia (64,0%), principalmente debido a la espera de transporte o problemas en el departamento de emergencias.
Los dilemas diagnósticos y los ECG no diagnósticos causaron los retrasos más largos, mientras que los retrasos por paro cardíaco / choque cardiogénico tuvieron la mayor mortalidad (30,6%).

Conclusiones:

Los retrasos en el tratamiento persisten incluso dentro de los sistemas STEMI optimizados.
El impacto clínico de los retrasos durante la transferencia interhospitalaria para ICP depende de la causa específica del retraso.

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