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Title: | Performance analysis of a STEMI network: prognostic impact of the type of first medical contact facility |
Author: | de Diego, Oriol Rueda, Ferran Carrillo, Xavier Oliveras, Teresa Andrea, Rut Ouaddi, Nabil El Serra, Jordi Labata, Carlos Ferrer, Marc Martínez Membrive, María J. Montero, Santiago Mauri, Josepa García Picart, Joan Rojas, Sergio Ariza, Albert Tizon Marcos, Helena Faiges, Marta Cárdenas, Mérida Lidón, Rosa María Muñoz Camacho, Juan F. Jiménez Fàbrega, Xavier Lupón, Josep Bayes Genis, Antoni García García, Cosme Codi Infart Registry Investigators |
Keywords: | Serveis d'urgències mèdiques Pronòstic mèdic Emergency Medical Services Prognosis |
Issue Date: | 1-Sep-2023 |
Publisher: | Elsevier BV |
Abstract: | Prognosis in ST-elevation myocardial infarction (STEMI) is determined by delay in primary percutaneous coronary intervention (PPCI). The impact of first medical contact (FMC) facility type on reperfusion delays and mortality remains controversial.We performed a prospective registry of primary coronary intervention (PCI)-treated STEMI patients (2010-2020) in the Codi Infart STEMI network. We analyzed 1-year all-cause mortality depending on the FMC facility type: emergency medical service (EMS), community hospital (CH), PCI hospital (PCI-H), or primary care center (PCC).We included 18?332 patients (EMS 34.3%; CH 33.5%; PCI-H 12.3%; PCC 20.0%). Patients with Killip-Kimball classes III-IV were: EMS 8.43%, CH 5.54%, PCI-H 7.51%, PCC 3.76% (P?<?.001). All comorbidities and first medical assistance complications were more frequent in the EMS and PCI-H groups (P?<?.05) and were less frequent in the PCC group (P?<?.05 for most variables). The PCI-H group had the shortest FMC-to-PCI delay (median 82?minutes); the EMS group achieved the shortest total ischemic time (median 151?minutes); CH had the longest reperfusion delays (P?<?.001). In an adjusted logistic regression model, the PCI-H and CH groups were associated with higher 1-year mortality, OR, 1.22 (95%CI, 1.00-1.48; P?=?.048), and OR, 1.17 (95%CI 1.02-1.36; P?=?.030), respectively, while the PCC group was associated with lower 1-year mortality than the EMS group, OR,?0.71 (95%CI 0.58-0.86; P?<?.001).FMC with PCI-H and CH was associated with higher adjusted 1-year mortality than FMC with EMS. The PCC group had a much lower intrinsic risk and was associated with better outcomes despite longer revascularization delays.Copyright © 2023 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved. |
Note: | Reproducció del document publicat a: https://doi.org/10.1016/j.rec.2022.12.010 |
It is part of: | Rev Esp Cardiol (Engl Ed), 2023, vol. 76, num. 9, p. 708-718 |
URI: | http://hdl.handle.net/2445/208346 |
Related resource: | https://doi.org/10.1016/j.rec.2022.12.010 |
ISSN: | 1885-5857 |
Appears in Collections: | Articles publicats en revistes (IDIBAPS: Institut d'investigacions Biomèdiques August Pi i Sunyer) |
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REC-D-22-00526_R2_removed.pdf | 2.86 MB | Adobe PDF | View/Open |
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