Impact of an Evaluation System of Times to Reperfusion in ST-segment Elevation Acute Myocardial Infarction

Alfonsina Candiello, Fernando Cohen, Leandro Lasave, Lorena Villagra, Guillermo Mulinaris, César Rodrigo Zoni, Alejandro García Escudero, Rubén Kevorkian, Ignacio Cigalini, Pedro Zangroniz

Abstract


Background: Treatment of patients with ST-elevation myocardial infarction (STEMI) is time-dependent; therefore centers withprimary percutaneous coronary intervention (pPCI) capability should be organized to achieve rapid reperfusion.Objectives: The aim of this study was to assess the impact of a systematic evaluation of reperfusion times with periodic feedback ofresults in reducing delays to treatment.Methods: This was an observational, prospective study conducted in 46 centers with 24/7 pPCI capability participating in the Stent-Save a Life! Argentina Initiative. Patients with STEMI who underwent pPCI within 12 hours from the onset of symptoms wereincluded from March 2016 to February 2019. The population was divided into three consecutive stages lasting one year each sincethe inclusion of each center in the Stent-Save a Life! Initiative.Results: A total of 3,492 patients were included (1st year: 1,482, 2nd year: 1,166, 3rd year: 844). There was a significant reductionin door-to-balloon (DTB) time (68, 60 and 50 min; p <0.0001), regardless of the type of first medical contact (FMC), and of the timefrom FMC to reperfusion (115, 112 and 98 min; p <0.0001), without differences in time from the onset of symptoms to FMC or totalischemic time (TIT). In addition, patients with FMC in centers without PCI capability who were referred for pPCI also evidenced asignificant reduction of TIT (274, 260 and 235 min; p <0.001).Conclusion: The implementation of a DTB program in centers with pPCI capability resulted in a significant reduction of treatmenttimes.

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Revista argentina de cardiología. ISSN en línea 1850-3748. Argentine journal of cardiology (English ed. Online ISSN 2314-2286) Sociedad Argentina de Cardiología. Azcuénaga 980 (C1115AAD),Ciudad Autónoma de Buenos Aires, República Argentina. Tel. (54 11) 4961-6027/8/9 Fax: 4961-6020 www.sac.org.ar revista@sac.org.ar