Metrics of care and cardiovascular outcomes in patients with ST-elevation myocardial infarction treated with pharmacoinvasive strategy: a decade-long network in a populous city in Brazil

BMC Cardiovascular Disorders

Research

Pedro Ivo De Marqui Moraes¹  Iran Goncalves¹  Dirceu Rodrigues de Almeida¹  Antonio Carlos Carvalho¹  Jose Marconi Almeida de Sousa¹  Henrique Tria Bianco¹  Claudia Maria Rodrigues Alves¹  Attilio Galhardo¹  Adriano Henrique Pereira Barbosa¹  Rui Manuel dos Santos Povoa¹  Edson Stefanini¹  Valdir Ambrosio Moises¹  Francisco Antonio Helfenstein Fonseca¹  Maria Cristina de Oliveira Izar¹  Renato Delascio Lopes²  Adriano Caixeta³ 

[1] Discipline of Cardiology, Department of Medicine, Universidade Federal de Sao Paulo, Rua Napoleao de Barros, 715, Ground Floor, Hospital Sao Paulo, Vila Clementino, CEP (ZIP) 04024-002, Sao Paulo, SP, Brazil;Discipline of Cardiology, Department of Medicine, Universidade Federal de Sao Paulo, Rua Napoleao de Barros, 715, Ground Floor, Hospital Sao Paulo, Vila Clementino, CEP (ZIP) 04024-002, Sao Paulo, SP, Brazil;Duke University Hospital, Duke Clinical Research Institute, DUMC, Box 3850, 2400 Pratt Street, Terrace Level Room 0311, 27705, Durham, NC, USA;Discipline of Cardiology, Department of Medicine, Universidade Federal de Sao Paulo, Rua Napoleao de Barros, 715, Ground Floor, Hospital Sao Paulo, Vila Clementino, CEP (ZIP) 04024-002, Sao Paulo, SP, Brazil;Hospital Israelita Albert Einstein, Av. Albert Einstein, 627/701 - Morumbi, CEP (ZIP) 05652-900, Sao Paulo, SP, Brazil;

关键词: ST Elevation Myocardial Infarction;    Thrombolytic Therapy;    Myocardial Reperfusion;    Pharmacoinvasive strategy;   

DOI  :  10.1186/s12872-023-03340-6

 received in 2022-12-15, accepted in 2023-06-09,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundPharmacoinvasive strategy is an effective myocardial reperfusion therapy when primary percutaneous coronary intervention (p-PCI) cannot be performed in a timely manner.MethodsAuthors sought to evaluate metrics of care and cardiovascular outcomes in a decade-long registry of a pharmacoinvasive strategy network for the treatment of ST-elevation myocardial infarction (STEMI). Data from a local network including patients undergoing fibrinolysis in county hospitals and systematically transferred to the tertiary center were accessed from March 2010 to September 2020. Numerical variables were described as median and interquartile range. Area under the curve (AUC-ROC) was used to analyze the predictive value of TIMI and GRACE scores for in-hospital mortality.ResultsA total of 2,710 consecutive STEMI patients aged 59 [51–66] years, 815 women (30.1%) and 837 individuals with diabetes (30.9%) were analyzed. The time from symptom onset to first-medical-contact was 120 [60–210] minutes and the door-to-needle time was 70 [43–115] minutes. Rescue-PCI was required in 929 patients (34.3%), in whom the fibrinolytic-catheterization time was 7.2 [4.9–11.8] hours, compared to 15.7 [6.8–22,7] hours in those who had successful lytic reperfusion. All cause in-hospital mortality occurred in 151 (5.6%) patients, reinfarction in 47 (1.7%) and ischemic stroke in 33 (1.2%). Major bleeding occurred in 73 (2.7%) patients, including 19 (0.7%) cases of intracranial bleeding. C-statistic confirmed that both scores had high predictive values for in-hospital mortality, demonstrated by TIMI AUC-ROC of 0.80 [0,77–0.84] and GRACE AUC-ROC of 0.86 [0.83—0.89].ConclusionIn a real world registry of a decade-long network for the treatment of ST-elevation myocardial infarction based on the pharmacoinvasive strategy, low rates of in-hospital mortality and cardiovascular outcomes were observed, despite prolonged time metrics for both fibrinolytic therapy and rescue-PCI. Register Clinicaltrials.gov NCT02090712 date of first registration 18/03/2014.

【 授权许可】

CC BY   
© The Author(s) 2023

【 图 表 】

42004_2023_919_Article_IEq130.gif

41116_2023_37_Article_IEq271.gif

41116_2023_37_Article_IEq219.gif