Predictors of Late Reperfusion in STEMI Patients Undergoing Primary Angioplasty. Impact of the Place of First Medical Contact.pdfVIP

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Predictors of Late Reperfusion in STEMI Patients Undergoing Primary Angioplasty. Impact of the Place of First Medical Contact.pdf

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Predictors of Late Reperfusion in STEMI Patients Undergoing Primary Angioplasty. Impact of the Place of First Medical Contact.pdf

Rev Esp Cardiol. 2017;70(3):162–169 Original article Predictors of Late Reperfusion in STEMI Patients Undergoing Primary Angioplasty. Impact of the Place of First Medical Contact Antoni Carol Ruiz,a,* Josep Masip Utset,b and Albert Ariza Sole′ c; on behalf of the researchers of the Codi Infart registry of Catalonia^ a Servicio de Cardiolog?′a, Unidad de Hospitalizacio′n, Hospital Moise′s Broggi, Consorci Sanitari Integral (CSI), Sant Joan Desp?′, Barcelona, Spain b Servicio de Medicina Intensiva, Hospital Moise′s Broggi, Consorci Sanitari Integral (CSI), Sant Joan Desp?′, Barcelona, Spain c Servicio de Cardiolog?′a, Unidad de Cuidados Agudos Cardiolo′gicos, Hospital Universitario de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain Article history: Received 14 March 2016 Accepted 15 September 2016 Available online 27 December 2016 Keywords: Myocardial infarction Reperfusion Coronary angiography Coronary angioplasty First medical assistance ABSTRACT Introduction and objectives: The bene?t of primary angioplasty may be reduced if there are delays to reperfusion. Identi?cation of the variables associated with these delays could improve health care. Methods: Analysis of the Codi Infart registry of Catalonia and of the time to angioplasty depending on the place of ?rst medical contact. Results: In 3832 patients analyzed, ?rst medical contact took place in primary care centers in 18% and in hospitals without a catheterization laboratory in 37%. Delays were longer in these 2 groups than in patients attended by the outpatient emergency medical system or by hospitals with a catheterization laboratory (P .0001, results in median): ?rst medical contact to reperfusion indication time was 42 minutes in both (overall 35 minutes); ?rst medical contact to artery opening time was 131 and 143 minutes, respectively (overall 121 minutes); total ischemia time was 230 and 260 minutes (overall 215 minutes). First medical contact to artery opening time 120 minutes was strongly assoc