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Vol. 76. Issue 9.
Pages 708-718 (September 2023)
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Vol. 76. Issue 9.
Pages 708-718 (September 2023)
Original article
Performance analysis of a STEMI network: prognostic impact of the type of first medical contact facility
Análisis de una red de atención al IAMCEST: impacto pronóstico del tipo de primer contacto médico
Oriol de Diegoa,b,c,
Corresponding author
orioldediego@gmail.com

Corresponding author:
, Ferran Ruedad, Xavier Carrillod, Teresa Oliverasd, Rut Andreaa,b, Nabil el Ouaddid, Jordi Serrad, Carlos Labatad, Marc Ferrerd, María J. Martínez-Membrived, Santiago Monterod, Josepa Maurid,f, Joan García-Picartg, Sergio Rojash, Albert Arizai, Helena Tizón-Marcosj,k,e, Marta Faigesl, Mérida Cárdenasm, Rosa María Lidónn,e, Juan F. Muñoz-Camachoo..., Xavier Jiménez Fàbregap, Josep Lupónd,e,q, Antoni Bayés-Genísd,e,q, Cosme García-Garcíad,e,q, on behalf of the Codi Infart registry investigators Ver más
a Servicio de Cardiología, Institut Clínic Cardiovascular, Hospital Clínic Barcelona, Barcelona, Spain
b Institut D’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
c Doctorando, Programa de doctorado, Department de Medicina, Universitat Autònoma de Barcelona, Spain
d Servicio de Cardiología, Institut del Cor, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
e Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
f Servei Català de Salut, Generalitat de Catalunya, Registre del Codi Infart, Barecelona, Spain
g Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
h Servicio de Cardiología, Hospital Joan XXIII, Tarragona, Spain
i Servicio de Cardiología, Hospital Universitari de Bellvitge, Barcelona, Spain
j Servicio de Cardiología, Hospital del Mar, Barcelona, Spain
k Heart Diseases Biomedical Research Group, Instituto de investigaciones Hospital del Mar (IMIM), Barcelona, Spain
l Servicio de Cardiología, Hospital de Tortosa Verge de la Cinta, IISPV, Tarragona, Spain
m Servicio de Cardiología, Hospital Universitari Josep Trueta, Girona, Spain
n Servicio de Cardiología, Hospital Vall d’Hebron, Barcelona, Spain
o Servicio de Cardiología, Hospital Mútua de Terrassa, Terrassa, Barcelona, Spain
p Sistema d’Emergències Mèdiques, Barcelona, Spain
q Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain
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Figures (5)
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Tables (5)
Table 1. Baseline and clinical characteristics. Patients from 2010 to 2020
Table 2. Delays to reperfusion and mortality depending on first medical care facility type. Patients from the entire study period
Table 3. Baseline and clinical characteristics. Patients from 2020
Table 4. Delays to reperfusion and mortality depending on FMC facility type in 2020
Table 5. Multiple logistic regressions for 30-day and 1-year mortality in the full period, from 2010 to 2019 and in 2020
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Additional material (1)
Abstract
Introduction and objectives

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.

Methods

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).

Results

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).

Conclusions

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.

Keywords:
Myocardial infarction
ST-elevation myocardial infarction (STEMI)
Percutaneous coronary intervention
Transfer
Network
Treatment delay
Total ischemic time
Abbreviations:
CH
EMS
PCC
PCI-H
PPCI
STEMI
Resumen
Introducción y objetivos

El tipo de primer contacto médico (PCM) en una red de angioplastia (ICPP) para el infarto con elevación del ST (IAMCEST) se asocia con diferentes grados de demora hasta ICPP y podría condicionar el pronóstico.

Métodos

Registro de IAMCEST tratados con ICPP (2010-2020) en la red Codi Infart. Analizamos la mortalidad al año por cualquier causa según el tipo de PCM: servicio de emergencias médicas (SEM), hospital comarcal (HC), hospital de angioplastia (H-ICP) y centro de atención primaria (CAP).

Resultados

Incluimos 18.332 pacientes (SEM 34,3%; HC 33,5%; H-ICP 12,3%; CAP 20,0%). La proporción de clases Killip III-IV fue: SEM 8,43%, HC 5,54%, H-ICP 7,51%, CAP 3,76% (p <0.001). Comorbilidades y complicaciones en el PCM fueron más frecuentes en los grupos SEM y H-ICP (p <0.05), y menores en el grupo CAP. El grupo H-ICP obtuvo el mejor tiempo PCM-ICPP (mediana 82 min); el grupo SEM consiguió el menor tiempo total de isquemia (mediana 151 min); el grupo HC obtuvo los mayores retrasos (p <0.001). En un modelo de regresión logística ajustado, los grupos H-ICP y HC se asociaron con mayor mortalidad, OR=1,22 (IC95% 1,00-1,48; p=0.048) y OR=1,17 (IC95% 1,02-1,36; p=0,030) respectivamente, y el grupo CAP con menor mortalidad que el grupo SEM, OR=0,71 (IC95% 0,58-0,86; p <0.001).

Conclusiones

El PCM con H-ICP y HC se asoció con mayor mortalidad ajustada a 1 año en comparación con el SEM. El grupo CAP se asoció con mejor pronóstico a pesar de reperfusiones más tardías.

Palabras clave:
Infarto de miocardio
Infarto con elevación del ST
IAMCEST
Intervencionismo coronario percutáneo
Retraso del sistema
Isquemia

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