System Delay and Mortality Among Patients With STEMI Treated With Primary Percutaneous Coronary Intervention

Terkelsen, Christian Juhl

doi:10.1001/jama.2010.1139

Cited by 581 publications

(449 citation statements)

References 32 publications

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“…The relationship between hyperglycemia and duration of symptoms might indicate that the early presenters with more pronounced symptoms and faster reaction are at higher risk (36). Importantly, there was no difference in system delay, which is a stronger predictor than time from the onset of symptoms to balloon angioplasty (37,38). Thus, it seems more plausible that hyperglycemia upon hospital admission in STEMI patients is an indicator of increased myocardium area at risk and a marker for the severity of the myocardial damage, rather than being a deteriorating factor in itself.…”

Section: Discussionmentioning

confidence: 95%

Impact of Acute Hyperglycemia on Myocardial Infarct Size, Area at Risk, and Salvage in Patients With STEMI and the Association With Exenatide Treatment: Results From a Randomized Study

et al. 2014

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Hyperglycemia upon hospital admission in patients with ST-segment elevation myocardial infarction (STEMI) occurs frequently and is associated with adverse outcomes. It is, however, unsettled as to whether an elevated blood glucose level is the cause or consequence of increased myocardial damage. In addition, whether the cardioprotective effect of exenatide, a glucose-lowering drug, is dependent on hyperglycemia remains unknown. The objectives of this substudy were to evaluate the association between hyperglycemia and infarct size, myocardial salvage, and area at risk, and to assess the interaction between exenatide and hyperglycemia. A total of 210 STEMI patients were randomized to receive intravenous exenatide or placebo before percutaneous coronary intervention. Hyperglycemia was associated with larger area at risk and infarct size compared with patients with normoglycemia, but the salvage index and infarct size adjusting for area at risk did not differ between the groups. Treatment with exenatide resulted in increased salvage index both among patients with normoglycemia and hyperglycemia. Thus, we conclude that the association between hyperglycemia upon hospital admission and infarct size in STEMI patients is a consequence of a larger myocardial area at risk but not of a reduction in myocardial salvage. Also, cardioprotection by exenatide treatment is independent of glucose levels at hospital admission. Thus, hyperglycemia does not influence the effect of the reperfusion treatment but rather represents a surrogate marker for the severity of risk and injury to the myocardium.

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Section: Discussionmentioning

confidence: 95%

Impact of Acute Hyperglycemia on Myocardial Infarct Size, Area at Risk, and Salvage in Patients With STEMI and the Association With Exenatide Treatment: Results From a Randomized Study

et al. 2014

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“…(1) According to the ESC guidelines, (1) it is a CLASS 1 A recommendation that STEMI patients presenting to a hospital with PCI capability should be treated with primary PCI within 90 minutes of first medical contact (FMC), while it is a CLASS 1 B recommendation that STEMI patients presenting to a hospital without PCI capability, and who cannot be transferred to a PCI center and Adriaan Snyders * and Rhena Delport # Autumn 2015 Volume 12 • Number 2 essary case fatalities. (3,4) Ideally patients should have access to a referral pathway to p-PCI that is managed by informed professionals and is free of delays and bottlenecks. Patient, system and other delays contribute to the inability to meet quality targets.…”

Section: These Objectives Accord With the European Society Ofmentioning

confidence: 99%

Referral pathways for reperfusion of STEMI – developing strategies for appropriate intervention

Snyders

Delport

2017

SAHJ

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undergo PCI within 90 minutes of FMC, should be treated with fibrinolytic therapy within 30 minutes of hospital presentation, unless such therapy is contraindicated.A recent study in STEMI patients found that while p-PCI was performed in 60%, the majority of the interventions occurred later than 120 minutes, and that only 36% received fibrinolysis.(2) This high percentage of patients receiving angiographyand an invasive treatment strategy may be explained by the location of the participating centers in urban areas, almost all of which were private healthcare facilities.Early and appropriate pre-hospital diagnosis, as well as immediate transport, are of vital importance to avoid unnec- ABSTRACT

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“…In this context, delays between symptom onset and use of first device in the culprit artery are excellent quality indicators. 16 The most notable improvement was observed in patient delay, which decreased from 118 min at Moment Zero to 112 min at Moment One. In particular, a greater number of patients reached FMC within one hour of the first symptom (23% vs. 35%).…”

Section: Achievements During the First Year Of The Sfl Portugal Initimentioning

confidence: 91%

Stent for Life in Portugal: This initiative is here to stay

Pereira

Pinto

Calé

et al. 2014

Revista Portuguesa de Cardiologia (English Edition)

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System Delay and Mortality Among Patients With STEMI Treated With Primary Percutaneous Coronary Intervention

Cited by 581 publications

References 32 publications

Impact of Acute Hyperglycemia on Myocardial Infarct Size, Area at Risk, and Salvage in Patients With STEMI and the Association With Exenatide Treatment: Results From a Randomized Study

Impact of Acute Hyperglycemia on Myocardial Infarct Size, Area at Risk, and Salvage in Patients With STEMI and the Association With Exenatide Treatment: Results From a Randomized Study

Referral pathways for reperfusion of STEMI – developing strategies for appropriate intervention

Stent for Life in Portugal: This initiative is here to stay

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