Key result
Access to primary PCI for STEMI patients did not significantly improve between 2010 and 2014-2015 (57% vs 56%, P=0.536), mainly due to persistent late presentation and prior thrombolysis.
Why the study?
Fast access to PPCI improves hospital outcomes in STEMI, and the authors sought to evaluate whether patient access to a PPCI facility improved over time with enhanced public awareness and expanding evidence-based health provision.
Does the time period of presentation (2014-2015 vs 2010) improve access to primary percutaneous coronary intervention and hospital mortality in STEMI patients?
Observational (n=511)
No
Does the time period of presentation (2014-2015 vs 2010) improve access to primary percutaneous coronary intervention and hospital mortality in STEMI patients?
Absolute Event Rate: 57% vs 56%
p-value: p=0.536
Access to primary PCI and hospital mortality for STEMI patients did not significantly improve between 2010 and 2014-2015 at a single center, primarily due to persistent late presentation and prior thrombolysis.
No improvement in primary PCI access for STEMI highlights persistent barriers; leaves open whether targeted strategies can enhance timely reperfusion in similar settings.
Background: The reperfusion therapy using primary percutaneous coronary intervention (PPCI) in ST-segment elevation myocardial infarction (STEMI) is known to give a better result than fibrinolytic therapy. The fast access to PPCI will improve hospital outcome. We believe that patient access to PPCI facility would have improved due to enhanced public awareness and expanding evidenced-based health provision. Methods: This is a single-center retrospective study to analyze and compare data for STEMI patients. Patients were transferred to our hospital during the year 2010. Group l comprised 223 patients. Group 2 comprised 288 patients. Group 2 patients were those treated between August 2014 and August 2015. We compared their demographic and baseline characteristics, patients' access to the hospital, reasons for no access, and hospital mortality for the two groups. Results: Among the 288 patients in Group 2, 247 patients (85%) were males with an average age of 57 years, 49% were diabetics, 48% were hypertensive, 48% were smokers, and 27% were obese. These were not different in Group 1. In Group 2, 164 patients (57%) only had access to PPCI compared to 56% in Group 1 (P = 0.536-NS). In G2, the main reasons for no PPCI were late presentation in 47% versus 53% in Group 1; P = 0.34 NS. In Group 2, 27% were due to thrombolysis versus 17% in Group 1 (P = 0.11 NS). Hospital mortality in Group 2 was 4% in those treated with PPCI compared to 2.3% in Group 1 (P = 0.522-NS). Mortality in patients who did not receive PPCI in Group 2 was 8% compared to 11.3% in Group 1 (P = 0.49-NS). Females in Group 2 have about 3 times higher mortality. Patients treated for STEMI in the last 12 months at King Abdulaziz Cardiac Center still have relatively low access to PPCI due mainly to persistent pattern of late presentation and prior thrombolysis, which reflect apparent lack of direct access to hospitals with PPCI facilities. Conclusion: Comparing the two periods, there was no change in cardiology practice. The low access to PPCI was mainly due to late presentation and prior thrombolysis. Hospital mortality rate for patients treated with PPCI remained low during the two era. This seemingly relates to both lack of public awareness and health provision factors in PPCI organizations.
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MohammedAli Balghith (2020) conducted an observational in ST-segment elevation myocardial infarction (STEMI) (n=511). Later time period (2014-2015) vs. Earlier time period (2010) was evaluated on Access to primary percutaneous coronary intervention (PPCI) (p=0.536). Access to primary PCI for STEMI patients did not significantly improve between 2010 and 2014-2015 (57% vs 56%, P=0.536), mainly due to persistent late presentation and prior thrombolysis.
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