Global geographical variations in ST-segment elevation myocardial infarction management and post-discharge mortality

Rosselló, Xavier; Huo, Yong; Pocock, Stuart J.; Werf, Frans Van de; Chin, Chee Tang; Danchin, Nicolás; Lee, Stephen W.L.; Medina, Jesús; Vega, Ana María Fernández; Bueno, Héctor

doi:10.1016/j.ijcard.2017.07.039

Cited by 107 publications

(92 citation statements)

References 34 publications

(36 reference statements)

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“…While data from tertiary hospitals located in urban areas in Brazil19 28 29 and in Sri Lanka30 showed prescription of over 80% of the drugs recommended by guidelines, utilisation rates were much lower in other studies performed in rural Brazil10 India16 and Chile 31. There are multiple causes for the low use of essential drugs, including irregular availability, absence of or non-adherence to clinical protocols and lack of training or feedback by quality assurance programmes.…”

Section: Barriers For MI Systems Of Care Implementation In Lmicsmentioning

confidence: 80%

Implementing myocardial infarction systems of care in low/middle-income countries

Nascimento

Brant

Marino

et al. 2018

Heart

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Ischaemic heart disease is the leading cause of death worldwide, with an increasing trend from 6.1 million deaths in 1990 to 9.5 million in 2016, markedly driven by rates observed in low/middle-income countries (LMIC). Improvements in myocardial infarction (MI) care are crucial for reducing premature mortality. We aimed to evaluate the main challenges for adequate MI care in LMIC, and possible strategies to overcome these existing barriers.Reperfusion is the cornerstone of MI treatment, but worldwide around 30% of patients are not reperfused, with even lower rates in LMIC. The main challenges are related to delays associated with patient education, late diagnosis and inadequate referral strategies, health infrastructure and insufficient funding. The implementation of regional MI systems of care in LMIC, systematising timely reperfusion strategies, access to intensive care, risk stratification and use of adjunctive medications have shown some successful strategies. Telemedicine support for remote ECG, diagnosis and organisation of referrals has proven to be useful, improving access to reperfusion even in prehospital settings. Organisation of transport and referral hubs based on anticipated delays and development of MI excellence centres have also resulted in better equality of care. Also, education of healthcare staff and task shifting may potentially widen access to optimal therapy.In conclusion, efforts have been made for the implementation of MI systems of care in LMIC, aiming to address particularities of the health systems. However, the increasing impact of MI in these countries urges the development of further strategies to improve reperfusion and reduce system delays.

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Section: Barriers For MI Systems Of Care Implementation In Lmicsmentioning

confidence: 80%

Implementing myocardial infarction systems of care in low/middle-income countries

Nascimento

Brant

Marino

et al. 2018

Heart

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“…Dominating causes of hospital admission of patients with CVDs include coronary heart disease, heart failure and cardiomyopathy, stroke, peripheral vascular disease, and others. Acute myocardial infarction (AMI) is the lethal manifestation of coronary artery disease associated with increased morbidity and mortality [4]. Coronary thrombosis, a sudden restriction or decrease in blood flow due to the rupture of atherosclerotic plaque, is the leading precipitant of AMI [5].…”

Section: Introductionmentioning

confidence: 99%

Impact of Temperature Variation on Acute Myocardial Infarction in Karachi, Pakistan

Khowaja

Karim

Zahid

et al. 2019

Cureus

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IntroductionEnvironmental triggers of acute myocardial infarction (AMI) have gained mounting evidence from various geographies of the world. However, due to geographic variations in seasonal temperature and other metrological parameters, it is difficult to generalize the findings in one population to another population with different climatic conditions. Therefore, the aim of this study was to assess the relationship between meteorological parameters and the number of primary percutaneous coronary intervention (PCI) procedures for AMI at a tertiary care cardiac hospital in Karachi, Pakistan.MethodsFor this cross-sectional study, data was obtained on the number of primary PCI procedures conducted at the National Institute of Cardiovascular Diseases (NICVD) Karachi, Pakistan during 1st June 2016 to 31st May 2018. Daily meteorological data of the Karachi region for the same period was obtained from the Pakistan Meteorological Department. It consists of temperature, atmospheric pressure, and relative humidity. Based on the weather conditions of Karachi, the data was divided into two seasons; summer (April to October) and winter (November to March). Multiple linear regression analysis was performed taken the number of primary PCI performed as regressand and time trend, average temperature, temperature variation, and relative humidity as regressors.ResultsA total of 115,494 hospital admissions were recorded during the study period out of which rate of primary PCI was 10.5% (12,107). A negative relationship between average temperature and number of primary PCI was observed with standardized regression coefficients of -0.13 (p < 0.001) on the overall regression model. A similar significant negative relationship of average temperature was observed on the regression model for the cold season with standardized regression coefficients of -0.17 (p < 0.001). While no such relationship was observed for the warm season.ConclusionThe average daily temperature was found to be negatively related to the number of primary PCI. Subgroup analysis revealed that the average daily temperature had a significant negative relationship with the number of primary PCI in the cold season; however, no such impact was observed in the warm season.

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“…In real‐world settings, access to primary PCI can be delayed or made impossible by geographical and economic hurdles, such as long distances to PCI centers, difficulties with traffic and transportation, and PCI centers not being open overnight or over weekends, or not being available at all . Delays to providing reperfusion therapy are common: in two large prospective observational studies, EPICOR (NCT01171404) and EPICOR Asia (NCT01361386), recruiting 11 559 patients with STEMI from 773 hospitals in 28 countries across Europe, Latin America, and Asia, the overall median time from symptom onset to reperfusion therapy was 5.8 hours for primary PCI (interquartile range [IQR]: 3.2‐13.5 hours) and 3.5 hours for fibrinolysis (IQR: 2.0‐6.0 hours) . There were large regional variations, with median time from symptom onset to primary PCI ranging from 3.9 hours in Southern and Northern Europe, South Korea, Hong Kong, and Singapore, to 20.9 hours in India, and median time to fibrinolysis ranging from 2.4 hours in Southern Europe to 6.3 hours in India (Figure ).…”

Section: Introductionmentioning

confidence: 99%

“…A, Use of reperfusion therapy; B, median time to primary PCI; and C, median time to fibrinolysis. Reproduced from Rossello et al 2017 . Abbreviations: IQR, interquartile range; PCI, percutaneous coronary intervention…”

Section: Introductionmentioning

confidence: 99%

“…These difficulties and regional variations are reflected in treatments used in clinical practice. In EPICOR and EPICOR Asia, rates of primary PCI ranged from 25% in India to 66% in Northern Europe, and of fibrinolysis from 8% in China to 34% in Southeast Asia (Figure ) . A large number of patients received no reperfusion therapy at all, ranging from approximately 20% in Europe, to 40% in Latin America and China, and 46% in India.…”

Section: Introductionmentioning

confidence: 99%

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Use of ticagrelor alongside fibrinolytic therapy in patients with ST‐segment elevation myocardial infarction: Practical perspectives based on data from the TREAT study

Berwanger

Abdelhamid

Alexander

et al. 2018

Clinical Cardiology

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Primary percutaneous coronary intervention (PCI) is the preferred reperfusion method in patients with ST-segment elevation myocardial infarction (STEMI). In patients with STEMI who cannot undergo timely primary PCI, pharmacoinvasive treatment is recommended, comprising immediate fibrinolytic therapy with subsequent coronary angiography and rescue PCI if needed. Improving clinical outcomes following fibrinolysis remains of great importance for the many patients globally for whom rapid treatment with primary PCI is not possible. For patients with acute coronary syndrome who underwent primary PCI, the PLATO trial demonstrated superior efficacy of ticagrelor relative to clopidogrel. Results in the predefined subgroup of patients with STEMI were consistent with the overall PLATO trial. Patients who received fibrinolytic therapy in the 24 hours before randomization were excluded from PLATO, and there is thus a lack of data on the safety of using ticagrelor in conjunction with fibrinolytic therapy in the first 24 hours after STEMI. The TREAT study addresses this knowledge gap; patients with STEMI who had symptom onset within the previous 24 hours and had received fibrinolytic therapy (of whom 89.4% had also received clopidogrel) were randomized to treatment with ticagrelor or clopidogrel (median time between fibrinolysis and randomization: 11.5 hours). At 30 days, ticagrelor was found to be non-inferior to clopidogrel for the primary safety outcome of Thrombolysis in Myocardial Infarction (TIMI)-defined first major bleeding. Considering together the results of the PLATO and TREAT studies, initiating or switching to treatment with ticagrelor within the first 24 hours after STEMI in patients receiving fibrinolysis is reasonable.

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Global geographical variations in ST-segment elevation myocardial infarction management and post-discharge mortality

Abstract: Among patients with STEMI, there is a wide regional variation in clinical profiles, hospital care and mortality. Substantial room for improvement remains at a global level for increasing reperfusion rates, reducing delays and post-discharge mortality in patients with STEMI.

Cited by 107 publications

References 34 publications

Implementing myocardial infarction systems of care in low/middle-income countries

Implementing myocardial infarction systems of care in low/middle-income countries

Impact of Temperature Variation on Acute Myocardial Infarction in Karachi, Pakistan

Use of ticagrelor alongside fibrinolytic therapy in patients with ST‐segment elevation myocardial infarction: Practical perspectives based on data from the TREAT study

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