Ventajas y desafíos del seguimiento de pacientes con infarto de miocardio con elevación del segmento ST con un panel...

Timely primary percutaneous coronary intervention (pPCI) is the most important treatment to improve outcomes in ST-segment elevation myocardial infarction (STEMI), with a strong relationship between treatment delays and morbidity and mortality. The present study aims to define the main steps for setting up a real-time digital monitoring dashboard to improve the clinical performance of STEMI management and to evaluate the impact of its implementation on the proportion of patients receiving primary percutaneous coronary intervention (pPCI) within 90 min.

The set-up of the digital monitoring system required the definition of detailed algorithms for the diagnosis, treatment, and rehab/follow-up phase. For each patient with a diagnosis of STEMI included in the clinical pathway (CP) a multidisciplinary working group identified i) rules for flagging patients alongside the CP, based on specific risk scores; ii) the critical points of the CP to be monitored, such as door-to-balloon time, intensive care unit length of stay, and total hospital length of stay. An interrupted time series analysis and multivariable logistic regression models were performed to assess for changes in the outcome (pPCI within 90 min) after the platform implementation, adjusting for temporal and individual confounders.

After the introduction of the dashboard, the proportion of timely pPCI improved from 40 % pre-implementation to 65 % post-implementation. Adjusted models indicated a twofold increase in the odds of meeting the 90-minute benchmark (OR = 2.00; 95 % CI: 0.99-4.12).

The real-time monitoring system showed a positive impact on the timely management of STEMI, highlighting the potential for improving healthcare efficiency and patient outcomes.