Management Strategies and Outcomes of <scp>ST</scp>‐Segment Elevation Myocardial Infarction Patients Transferred After Receiving Fibrinolytic Therapy in the United States

Patel, Nish; Patel, Nileshkumar; Thakkar, Badal; Singh, Vikas; Arora, Shilpkumar; Patel, Nilay; Savani, Chirag; Deshmukh, Abhishek; Thadani, Udho; Badheka, Apurva; Alfonso, Carlos; Fonarow, Gregg C.; Cohen, Mauricio G.

doi:10.1002/clc.22491

Cited by 6 publications

(6 citation statements)

References 30 publications

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“…The American Heart Association, American College of Cardiology, and European Society of Cardiology have guidelines strongly advocating a D2N time of less than 30 minutes when a fibrinolytic strategy is employed 19 A short D2B (under 90 minutes) has become the mantra for primary PCI, with a direct correlation between short D2B and both early and long-term mortality 21 . Current guidelines direct the pharmaco-invasive strategy beginning with fibrinolysis for patients for whom primary PCI cannot be provided in a timely fashion 1,2,22 . Despite the considerable progress, self-transportation, as opposed to ambulance transfer, is still widespread and is an independent predictor of inpatient mortality 23 .…”

Section: Discussionmentioning

confidence: 99%

Impact of a telemedicine-guided, population-based, STEMI network on reperfusion strategy, efficiency, and outcomes

Mehta¹,

Aboushi²,

Campos³

et al. 2021

AsiaIntervention

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Aims: A telemedicine-guided strategy increases the access to and efficiency of ST-elevation myocardial infarction (STEMI) networks resulting in increased access to, and reduced disparities in, acute myocardial infarction (AMI) care between rural and urban areas. Methods and results:The Latin America Telemedicine Infarct Network (LATIN) was developed for poor and remote regions in Brazil and Colombia that lacked coordinated AMI systems of care. It strategically connects small clinics and primary care health centres (spokes) to hubs with 24/7 percutaneous coronary intervention (PCI) capability. Experts at three remote sites provide urgent electrocardiogram (ECG) diagnosis and tele-consultation for the entire network. Data from the busiest LATIN site, the Santa Marcelina Hospital in Sao Paolo, Brazil, were compared with health statistics from Sistema Unico de Saude (Brazilian Public Health System -SUS). A total of 192 centres were networked using standardised and guidelinebased protocols for AMI care. Overall, 313,897 patients were remotely screened, 3,572 AMI diagnosed (1.1%), and 1,636 AMI urgently reperfused (45.8%), mainly by primary PCI (n=1,351; 83%).

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Section: Discussionmentioning

confidence: 99%

Impact of a telemedicine-guided, population-based, STEMI network on reperfusion strategy, efficiency, and outcomes

Mehta¹,

Aboushi²,

Campos³

et al. 2021

AsiaIntervention

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“…The lack of any difference in the mortality is possibly related to the late presentation prevalence of acute MI, a higher risk profile, and prior myocardial damage during previous PPCI or CABG. The STEMI network may decrease the deficit [ 6 , 7 ].…”

Section: Discussionmentioning

confidence: 99%

The Primary Management Strategies for ST-Elevation Myocardial Infarction Patients in Saudi Arabia: A Sub-Study of the Saudi Acute Myocardial Infarction Registry

Kinsara

Al-Saleh

Taher

et al. 2020

Cureus

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Background and objective Not all patients with ST-elevation myocardial infarction (STEMI) in Saudi Arabia are managed with a primary percutaneous coronary intervention (PPCI). We analyzed the management strategies for STEMI patients in the Saudi Acute Myocardial Infarction Registry (STARS). The strategies include PPCI, revascularization with thrombolytic therapy, and conservative management. This study involved a substudy of the STARS. Methods STEMI patients were categorized into three groups. Group 1 was managed with PPCI, group 2 with revascularization with thrombolytic therapy, and group 3 with conservative approaches. The data were collected at presentation, at one month, and at one year after discharge. Results The sample consisted of 1,471 patients. The mean age of the participants was 54 ±12 years; 51% were Saudi citizens, and the majority (89%) were male. Their background revealed a high coronary risk profile, with 48% diagnosed with diabetes mellitus (DM) and 44% with hypertension (HTN); 54% were active or ex-smokers, 30% had a high lipid profile, and 74% were overweight. PPCI was performed in 42%, and 29% were managed with revascularization using thrombolytic therapy. A conservative approach was followed in 29% of the patients. Patients who had a stroke were treated conservatively due to the risk of bleeding. The patients in group 1 were mostly hypertensive with recurrent angina and a history of prior revascularization, with PPCI or coronary artery bypass grafting (CABG). The crude all-cause mortality at one year was 11%; it was 7% at one month for group 1, 8% for group 2, and 9% for group 3, which was not statistically significant. Conclusions Controlling the risk factors and improving access to PPCI in hospitals are fundamental in the management of STEMI patients. PPCI is still underused. Guideline-directed medical therapy (GDMT) is a reasonable approach if PPCI is not available.

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“…Adult (>18 years) admissions with a primary diagnosis of STEMI [International Classification of Diseases‐9 Clinical Modification (ICD‐9CM) 410.1x‐410.6x, 410.8x, and 410.9x and International Classification of Diseases‐10 Clinical Modification (ICD‐10CM) I21.x‐22.x except I21.4, I 32.Ax, I22.2, and I21.9] and a secondary diagnosis of CS (ICD‐9CM 785.51; ICD‐10CM R57.0) were identified 20 . Fibrinolytic therapy was classified as that received either prior to transfer within the previous 24 h (ICD‐9CM V45.88; ICD‐10CM Z92.82) or on Hospital Day 0 during the index admission (ICD‐9CM 99.10; ICD‐10PCS 3E03317, 3E04317) 21,22 . The initial fibrinolysis cohort was compared with STEMI‐CS admissions receiving PPCI.…”

Section: Methodsmentioning

confidence: 99%

“…Because the ICD‐9CM for fibrinolysis prior to transfer was introduced in October 2008, we excluded all admissions before 1 January 2009. We also excluded admissions without information on timing of fibrinolysis or fibrinolysis received after Hospital Day 0, with alternate indications to receive fibrinolysis (pulmonary embolism and ischaemic stroke) and admissions managed medically or with CABG in the non‐fibrinolysis group 21,23 . Demographic characteristics, hospital characteristics, concomitant cardiac arrest, co‐morbidities, coronary angiography, PCI, CABG, mechanical circulatory support, and non‐cardiac organ support use were identified for all admissions using previously used methodologies from our group 2,24–27 .…”

Section: Methodsmentioning

confidence: 99%

“…20 Fibrinolytic therapy was classified as that received either prior to transfer within the previous 24 h (ICD-9CM V45.88; ICD-10CM Z92.82) or on Hospital Day 0 during the index admission (ICD-9CM 99.10; ICD-10PCS 3E03317, 3E04317). 21,22 The initial fibrinolysis cohort was compared with STEMI-CS admissions receiving PPCI. Because the ICD-9CM for fibrinolysis prior to transfer was introduced in October 2008, we excluded all admissions before 1 January 2009.…”

Section: Study Population Variables and Outcomesmentioning

confidence: 99%

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Fibrinolysis vs. primary percutaneous coronary intervention for ST‐segment elevation myocardial infarction cardiogenic shock

et al. 2021

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Aims There are limited contemporary data on the use of initial fibrinolysis in ST-segment elevation myocardial infarction cardiogenic shock (STEMI-CS). This study sought to compare the outcomes of STEMI-CS receiving initial fibrinolysis vs. primary percutaneous coronary intervention (PPCI). Methods Using the National (Nationwide) Inpatient Sample from 2009 to 2017, a comparative effectiveness study of adult (>18 years) STEMI-CS admissions receiving pre-hospital/in-hospital fibrinolysis were compared with those receiving PPCI. Admissions with alternate indications for fibrinolysis and STEMI-CS managed medically or with surgical revascularization (without fibrinolysis) were excluded. Outcomes of interest included in-hospital mortality, development of non-cardiac organ failure, complications, hospital length of stay, hospitalization costs, use of palliative care, and do-not-resuscitate status. Results During 2009-2017, 5297 and 110 452 admissions received initial fibrinolysis and PPCI, respectively. Compared with those receiving PPCI, the fibrinolysis group was more often non-White, with lower co-morbidity, and admitted on weekends and to small rural hospitals (all P < 0.001). In the fibrinolysis group, 95.3%, 77.4%, and 15.7% received angiography, PCI, and coronary artery bypass grafting, respectively. The fibrinolysis group had higher rates of haemorrhagic complications (13.5% vs. 9.9%; P < 0.001). The fibrinolysis group had comparable all-cause in-hospital mortality [logistic regression analysis: 28.8% vs. 28.5%; propensity-matched analysis: 30.8% vs. 30.3%; adjusted odds ratio 0.97 (95% confidence interval 0.90-1.05); P = 0.50]. The fibrinolysis group had comparable rates of acute organ failure, hospital length of stay, rates of palliative care referrals, do-not-resuscitate status use, and lesser hospitalization costs. Conclusions The use of initial fibrinolysis had comparable in-hospital mortality than those receiving PPCI in STEMI-CS in the contemporary era in this large national observational study.

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Management Strategies and Outcomes of ST‐Segment Elevation Myocardial Infarction Patients Transferred After Receiving Fibrinolytic Therapy in the United States

Cited by 6 publications

References 30 publications

Impact of a telemedicine-guided, population-based, STEMI network on reperfusion strategy, efficiency, and outcomes

Impact of a telemedicine-guided, population-based, STEMI network on reperfusion strategy, efficiency, and outcomes

The Primary Management Strategies for ST-Elevation Myocardial Infarction Patients in Saudi Arabia: A Sub-Study of the Saudi Acute Myocardial Infarction Registry

Fibrinolysis vs. primary percutaneous coronary intervention for ST‐segment elevation myocardial infarction cardiogenic shock

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