Abstract 4200: Primary Percutaneous Coronary Intervention Guidelines Compliance in ST Elevation Myocardial Infarction: Improvement Factors and Pre-hospital Emergency System
Purpose According to the current Guidelines, in ST-segment Elevation Myocardial Infarction (STEMI) Percutaneous Coronary Intervention (PCI) should be performed in the first 90 minutes after first medical contact and Total Ischemic Time (TIT) should be less than 120 minutes. The aim of this study was to analyze the contemporary model fitness to STEMI Guidelines in a tertiary PCI center.
Methods Prospective single center registry of 223 consecutive STEMI patients referred for primary PCI, between 2003 and 2007.
Results In this population (mean age 60±12 years, 76% male patients),TIT was 4h30m (<120 minutes in 4% of patients). The interval with better performance was time from first medical contact to the performance of the first ECG (8 minutes, <10 minutes in 59% of patients). The worst intervals were time from the onset of symptoms to first medical contact (104 minutes) and time from first ECG to PCI (140 minutes). The three more frequent origins were two hospitals from nearby cities [Hospital A: 6km (Hosp-A); Hospital B: 22km (Hosp-B)] and a pre-hospital emergency system (Pre-Hosp). The Pre-Hosp group had less TIT than Hosp-A or B (2h45m Vs 4h44m and 6h40m, p<0.05), with less door-to-balloon time [89min Vs 147min and 146min, p<0.05;CI:0.95). Shorter TIT was associated with better post-PCI TIMI flow (2 vs 3: 7:03 vs 4:17, p=0.02), better post-PCI TIMI frame count (>24 vs ≤24: 5:00 vs 4:11, p=0.03) and better ST-segment resolution (<70% vs ≥70%: 5:12 Vs 3:59 p=0.002).
Conclusions Only a minority of STEMI patients are within recommended time to revascularization, although the pre-hospital emergency system significantly reduces delays. Guideline compliance translates in better PCI outcome.