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Stemi care

James R Langabeer, Tiffany Champagne-Langabeer, Raymond Fowler, Timothy Henry
BACKGROUND: It is known that women generally have worse mortality outcomes than men with regards to ST-segment elevation myocardial infarction. However, less is known about contemporary gender differences in non-STEMI acute coronary syndrome, particularly those presenting to emergency departments within a regionalized system of care with standardized protocols. METHODS: Retrospective registry data from 2010 to 2016 were examined from the North Texas Mission: Lifeline system of care, representing 33 hospitals around the Dallas Texas metropolitan area...
May 7, 2018: American Journal of Emergency Medicine
Hélder Pereira, Rita Calé, Fausto J Pinto, Ernesto Pereira, Daniel Caldeira, Sofia Mello, Sílvia Vitorino, Manuel de Sousa Almeida, Jorge Mimoso
INTRODUCTION AND AIMS: Shorter patient delays are associated with a better prognosis for patients diagnosed with ST-segment elevation myocardial infarction (STEMI). This study aimed to identify predictors of patient delay in the Portuguese population. METHODS: Data on 994 patients with suspected STEMI of less than 12 hours' duration and referred for primary percutaneous coronary intervention (pPCI) and admitted to 18 Portuguese interventional cardiology centers were collected for a one-month period every year from 2011 to 2015...
May 8, 2018: Portuguese Journal of Cardiology: An Official Journal of the Portuguese Society of Cardiology
Poonam Velagapudi, Dhaval Kolte, Kashif Ather, Sahil Khera, Tanush Gupta, Paul C Gordon, Herbert D Aronow, Ajay J Kirtane, J Dawn Abbott
Improved procedural techniques and process of care initiatives have decreased length of stay (LOS) after primary percutaneous coronary intervention (PPCI) for ST-elevation myocardial infarction (STEMI). However, there remains a subset of patients who continue to require longer LOS. We used the 2005 to 2014 National Inpatient Sample databases to identify all hospitalizations for PPCI for STEMI in patients ≥18 years of age. Hospitalizations in which patients were discharged home alive were included. Multivariable linear and logistic regression models were used to examine temporal trends in LOS and to identify independent predictors of longer LOS (LOS >3 days)...
April 11, 2018: American Journal of Cardiology
Helmut Trimmel, Thomas Bayer, Wolfgang Schreiber, Wolfgang G Voelckel, Lukas Fiedler
BACKGROUND: Myocardial infarction is a time-critical condition and its outcome is determined by appropriate emergency care. Thus we assessed the efficacy of a supra-regional ST-segment elevation myocardial infarction (STEMI) network in Easternern Austria. METHODS: The Eastern Austrian STEMI network serves a population of approx. 766.000 inhabitants within a region of 4186 km2 . Established in 2007, it now comprises 20 pre-hospital emergency medical service (EMS) units (10 of these physician-staffed), 4 hospitals and 3 cardiac intervention centres...
May 9, 2018: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Surya Dharma, Iwan Dakota, Renan Sukmawan, Hananto Andriantoro, Bambang Budi Siswanto, Sunil V Rao
BACKGROUND: Studies with short-term follow-up found higher mortality in patients with STEMI who underwent primary PCI during off-hours as compared to regular working hours. We analyzed the interaction between one and two-year survival of patients with STEMI who underwent primary PCI during regular working hours and off-hours in a tertiary care academic teaching hospital. METHODS: A total of 1126 STEMI patients treated with primary PCI between 2008 and 2013 were analyzed...
March 22, 2018: Cardiovascular Revascularization Medicine: Including Molecular Interventions
Maame Yaa A B Yiadom, Bryn E Mumma, Christopher W Baugh, Brian W Patterson, Angela M Mills, Gilberto Salazar, Mary Tanski, Cathy A Jenkins, Timothy J Vogus, Karen F Miller, Brittney E Jackson, Christoph U Lehmann, Stephen C Dorner, Jennifer L West, Thomas J Wang, Sean P Collins, Robert S Dittus, Gordon R Bernard, Alan B Storrow, Dandan Liu
INTRODUCTION: Advances in ST-segment elevation myocardial infarction (STEMI) management have involved improving the clinical processes connecting patients with timely emergency cardiovascular care. Screening upon emergency department (ED) arrival for an early ECG to diagnose STEMI, however, is not optimal for all patients. In addition, the degree to which timely screening and diagnosis are associated with improved time to intervention and postpercutaneous coronary intervention outcomes, under more contemporary practice conditions, is not known...
May 3, 2018: BMJ Open
Jacqueline L Green, Alice K Jacobs, DaJuanicia Holmes, Karen Chiswell, Rosalia Blanco, Eric R Bates, William French, Douglas F Kupas, Greg Mears, Matthew Roe, Brahmajee K Nallamothu
BACKGROUND: Early success with regionalization of ST-segment-elevation myocardial infarction (STEMI) care has led many states to adopt statewide prehospital STEMI hospital destination policies, allowing emergency medical services to bypass non-percutaneous coronary intervention-capable hospitals. The association between adoption of these policies and patterns of care among STEMI patients is unknown. METHODS AND RESULTS: Using data from January 1, 2013, to December 31, 2014, from the National Cardiovascular Data Registry and Acute Coronary Treatment and Intervention Outcomes Network Registry, 6 states with bypass policies (cases included Delaware, Iowa, Maryland, North Carolina, Pennsylvania, and Massachusetts) were matched to 6 states without bypass policies (controls included South Carolina, Minnesota, Virginia, Texas, New York, and Connecticut) a priori on region, hospital density, and percent state participation in the registry...
May 2018: Circulation. Cardiovascular Interventions
Saba Ahmed, Ariba Khan, Syed Ibaad Ali, Mohammad Saad, Hafsa Jawaid, Mahnoor Islam, Hanieya Saiyed, Sarosh Fatima, Aiman Khan, Maleeha A Basham, Syeda Asfia Hussain, Maheen Akhtar, Fatima Kausar, Afshan Hussain, Kaneez Fatima
OBJECTIVE: A short pre-hospital delay, from the onset of symptoms to rapid initiation of reperfusion therapy, is a crucial factor in determining prognosis of myocardial infarction (MI). The purpose of this study was to evaluate symptoms and presentation delay times in MI patients with and without diabetes. METHODS: This cross-sectional study was conducted in 3 tertiary care hospitals of Pakistan over a period of 6 months. The study sample consisted of 280 consenting individuals diagnosed with ST-elevation MI (STEMI) or Non-ST elevation MI (NSTEMI), out of which 130 were diabetic and 150 were non-diabetic...
March 2018: Indian Heart Journal
Nicole T D'Arcy, Nichole Bosson, Amy H Kaji, Quang T Bui, William J French, Joseph L Thomas, Yvonne Elizarraraz, Natalia Gonzalez, Jose Garcia, James T Niemann
IntroductionField identification of ST-elevation myocardial infarction (STEMI) and advanced hospital notification decreases first-medical-contact-to-balloon (FMC2B) time. A recent study in this system found that electrocardiogram (ECG) transmission following a STEMI alert was frequently unsuccessful.HypothesisInstituting weekly test ECG transmissions from paramedic units to the hospital would increase successful transmission of ECGs and decrease FMC2B and door-to-balloon (D2B) times. METHODS: This was a natural experiment of consecutive patients with field-identified STEMI transported to a single percutaneous coronary intervention (PCI)-capable hospital in a regional STEMI system before and after implementation of scheduled test ECG transmissions...
April 30, 2018: Prehospital and Disaster Medicine
Jignesh K Patel, Ganesh Thippeswamy, Abdo Kataya, Charles A Loeb, Puja B Parikh
Coronary angiography is a key component of systematic, multi-disciplinary post-cardiac arrest (CA) care, however, coronary angiogram is not routinely performed in the setting of CA. We sought to identify the predictors of obstructive coronary artery disease (CAD) and mortality in adults with CA undergoing coronary angiogram. The study population included 208 consecutive patients hospitalized with CA who underwent resuscitation and subsequent coronary angiogram at an academic tertiary medical center. The primary outcome of interest was presence of obstructive CAD, defined as >1 coronary artery with >70% stenosis or >1 coronary bypass graft with >70% stenosis...
April 3, 2018: American Journal of Cardiology
Satoshi Higuchi, Makoto Suzuki, Yu Horiuchi, Hiroyuki Tanaka, Mike Saji, Hideaki Yoshino, Ken Nagao, Takeshi Yamamoto, Morimasa Takayama
Recent randomized clinical trials have questioned the clinical benefits of thrombus aspiration (TA) in ST-segment elevation myocardial infarction (STEMI). Real-world data on TA and the efficacy of TA for various culprit lesions have not been sufficiently evaluated. This study mainly aimed to evaluate whether the clinical impact of TA depends on culprit lesions in the setting of STEMI. We surveyed the Tokyo Coronary Care Unit Network Registry, a prospective cohort study, between 2010 and 2014, which included 10,232 patients with STEMI...
April 27, 2018: Heart and Vessels
Julien Turk, Magali Fourny, Komlavi Yayehd, Nicolas Picard, François-Xavier Ageron, Bastien Boussat, Loïc Belle, Gérald Vanzetto, Etienne Puymirat, José Labarère, Guillaume Debaty
OBJECTIVES: To compare timely access to reperfusion therapy and outcomes according to age of older adults with ST-segment elevation myocardial infarction (STEM) managed within an integrated regional system of care. DESIGN: Ongoing, prospective, regional, hospital-based clinical registry. SETTING: Twenty-three public and private hospitals in the Northern Alps in France. PARTICIPANTS: Individuals presenting with STEMI evolving for less than 12 hours from symptom onset between January 2009 and December 2015 (N=4,813; 3,716 (77...
April 23, 2018: Journal of the American Geriatrics Society
Enisa Hodzic, Semir Perla, Amer Iglica, Marina Vucijak
Introduction: Acute coronary syndrome (ACS) is one of the most common health problems in the world and the leading cause of death. Goal: The goals of this study are to determine: ACS type, risk factors, incidence and the seasonal distribution of occurrence Spring/Summer, Autumn/Winter, ACS incidence by age and gender, and complications (post-infarction angina and heart failure) and fatal outcomes of ACS per season. Material and methodology: This study is designed as retrospective-prospective and analytical, which included 250 patients hospitalized in the Intensive Cardiac care unit of the Clinic for heart disease, blood vessels and rheumatism in the period from June 2013 to July 2014...
March 2018: Materia Socio-medica
Sofia Sederholm Lawesson, Rose-Marie Isaksson, Ingela Thylén, Maria Ericsson, Karin Ängerud, Eva Swahn
BACKGROUND: Symptom presentation has been sparsely studied from a gender perspective restricting the inclusion to ST elevation myocardial infarction (STEMI) patients. Correct symptom recognition is vital in order to promptly seek care in STEMI where fast reperfusion therapy is of utmost importance. Female gender has been found associated with atypical presentation in studies on mixed MI populations but it is unclear whether this is valid also in STEMI. OBJECTIVES: We assessed whether there are gender differences in symptoms and interpretation of these in STEMI, and if this is attributable to sociodemographic and clinical factors...
March 24, 2018: International Journal of Cardiology
Francesca Fiorentino, Raquel Ascenção, Nicoletta Rosati
Objectives To investigate a possible weekend effect in the in-hospital mortality rate for acute myocardial infarction in Portugal, and whether the delay in invasive intervention contributes to this effect. Methods Data from the National 2011-2015 Diagnostic-Related-Group databases were analysed. The focus was on adult patients admitted via the emergency department and with the primary diagnosis of acute myocardial infarction. Patients were grouped according to ST-elevation myocardial infarction and non-ST-elevation myocardial infarction episodes...
January 1, 2018: Journal of Health Services Research & Policy
Sanjog Kalra, Hemal Bhatt, Ajay J Kirtane
The treatment of ST-segment elevation myocardial infarction (STEMI) has advanced dramatically over the past 30 years since the introduction of reperfusion therapies, such that mechanical reperfusion with primary percutaneous coronary intervention is now the standard of care. With STEMI, as with other forms of acute coronary syndrome, stent deployment in culprit lesions is the dominant form of reperfusion in the developed world and is supported by contemporary guidelines. However, the precise timing of stenting and the extent to which both culprit and non-culprit lesions should be treated continue to be active areas of study...
January 2018: Methodist DeBakey Cardiovascular Journal
Martina Ventura, Danilo Fusco, Katia Bontempi, Paola Colais, Marina Davoli
BACKGROUND: Inequalities in health among groups of various socio-economic status (as measured by education, occupation, and income) constitute one of the main challenges for public health. Since 2006, the Lazio Regional Outcome Evaluation Program (P.Re.Val.E.), presents a set of indicators of hospital performance based on quality standards driven by strong clinical recommendations, and measures the variation in the access to effective health care for different population groups and providers in the Lazio Region...
2018: PloS One
M Martínez-García, J Vargas-Barrón, F Bañuelos-Téllez, H González-Pacheco, C Fresno, E Hernández-Lemus, M A Martínez-Ríos, M Vallejo
OBJECTIVE: ST-segment elevation myocardial infarction (STEMI) has an important economic burden that poised the urgent need to evaluate its catastrophic medical expense. This study evaluates the first 5 years of the national health initiative called Popular Insurance (PI) at the National Institute of Cardiology in Mexico. STUDY DESIGN: Retrospective data analysis. METHODS: STEMI patients with (n=317) and without (n=260) PI were selected. Analysed variables included socio-economical context, management care, cost evaluation and three outcomes (mortality, hospital readmission and therapeutic adherence)...
March 13, 2018: Public Health
Pin Pin Pek, Huili Zheng, Andrew Fu Wah Ho, Win Wah, Huay Cheem Tan, Ling Li Foo, Marcus Eng Hock Ong
BACKGROUND: With an ageing population, there is a need to understand the relative risk/benefit of interventions for elderly ST segment elevation myocardial infarction (STEMI) patients. The primary aim of this study was to compare epidemiology, treatments and outcomes between young and elderly STEMI patients. Our secondary aim was to determine the cut-off age when the benefits of primary percutaneous coronary intervention (PCI) were less pronounced. METHODS: Data were collected by the Singapore Myocardial Infarction Registry...
May 2018: Emergency Medicine Journal: EMJ
Rajkumar Doshi, Jay Shah, Varun Jauhar, Dean Decter, Rajiv Jauhar, Perwaiz Meraj
BACKGROUND: The aim of this study was to analyze the indications for using bare metal stents (BMSs) in hospitalizations with ST segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI). METHODS: The study cohorts were identified from the National Inpatient Sample database from 2010-2014 using appropriate, International Classification of Diseases, 9th Revision, Clinical Modification, diagnostic and procedural codes. RESULTS: A total of 123,487 hospitalizations were identified for this study...
March 12, 2018: Heart & Lung: the Journal of Critical Care
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