Fibrinolytic therapy versus primary percutaneous coronary interventions for st-segment elevation myocardial infarction in kentucky

Time to establish systems of care?

Eric L. Wallace, John R. Kotter, Richard Charnigo, Liliana B. Kuvlieva, Susan S. Smyth, Khaled M. Ziada, Charles Campbell

Research output: Contribution to journalArticle

Abstract

Background: Fibrinolytic therapy is recommended for ST-segment myocardial infarctions (STEMI) when primary percutaneous coronary intervention (PPCI) is not available or cannot be performed in a timely manner. Despite this recommendation, patients often are transferred to PPCI centers with prolonged transfer times, leading to delayed reperfusion. Regional approaches have been developed with success and we sought to increase guideline compliance in Kentucky. Methods: A total of 191 consecutive STEMI patients presented to the University of Kentucky (UK) Chandler Medical Center between July 1, 2009 and June 30, 2011. The primary outcome was in-hospital mortality and the secondary outcomes were major adverse cardiovascular events, extent ofmyocardial injury, bleeding, and 4) length of stay. Patientswere analyzed by presenting facilityVtheUKhospital versus an outside hospital (OSH)Vand treatment strategy (PPCI vs fibrinolytic therapy). Further analyses assessed primary and secondary outcomes by treatment strategy within transfer distance and compliance with American Heart Association guidelines. Results: Patients presenting directly to the UK hospital had significantly shorter door-to-balloon times than those presenting to an OSH (83 vs 170 minutes; P G 0.001). This did not affect short-term mortality or secondary outcomes. By comparison, OSH patients treated with fibrinolytic therapy had a numeric reduction inmortality (4.0%vs 12.3%; P = 0.45). Overall, only 20% of OSH patients received timely reperfusion, 13% PPCI, and 42% fibrinolytics. In a multivariable model, delayed reperfusion significantly predictedmajor adverse cardiovascular events (odds ratio 3.87, 95% confidence interval 1.15Y13.0; P = 0.02), whereas the presenting institution did not. Conclusions: In contemporary treatment of STEMI in Kentucky, ongoing delays to reperfusion therapy remain regardless of treatment strategy. For further improvement in care, acceptance of transfer delays is necessary and institutions should adopt standardized protocols in association with a regional system of care.

Original languageEnglish (US)
Pages (from-to)391-398
Number of pages8
JournalSouthern medical journal
Volume106
Issue number7
DOIs
StatePublished - Jul 1 2013

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Thrombolytic Therapy
Percutaneous Coronary Intervention
Myocardial Infarction
Reperfusion
Guidelines
Therapeutics
Hospital Mortality
Compliance
Length of Stay
Odds Ratio
Confidence Intervals
Hemorrhage
Mortality
Wounds and Injuries

All Science Journal Classification (ASJC) codes

  • Medicine(all)

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Fibrinolytic therapy versus primary percutaneous coronary interventions for st-segment elevation myocardial infarction in kentucky : Time to establish systems of care? / Wallace, Eric L.; Kotter, John R.; Charnigo, Richard; Kuvlieva, Liliana B.; Smyth, Susan S.; Ziada, Khaled M.; Campbell, Charles.

In: Southern medical journal, Vol. 106, No. 7, 01.07.2013, p. 391-398.

Research output: Contribution to journalArticle

Wallace, Eric L. ; Kotter, John R. ; Charnigo, Richard ; Kuvlieva, Liliana B. ; Smyth, Susan S. ; Ziada, Khaled M. ; Campbell, Charles. / Fibrinolytic therapy versus primary percutaneous coronary interventions for st-segment elevation myocardial infarction in kentucky : Time to establish systems of care?. In: Southern medical journal. 2013 ; Vol. 106, No. 7. pp. 391-398.
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title = "Fibrinolytic therapy versus primary percutaneous coronary interventions for st-segment elevation myocardial infarction in kentucky: Time to establish systems of care?",
abstract = "Background: Fibrinolytic therapy is recommended for ST-segment myocardial infarctions (STEMI) when primary percutaneous coronary intervention (PPCI) is not available or cannot be performed in a timely manner. Despite this recommendation, patients often are transferred to PPCI centers with prolonged transfer times, leading to delayed reperfusion. Regional approaches have been developed with success and we sought to increase guideline compliance in Kentucky. Methods: A total of 191 consecutive STEMI patients presented to the University of Kentucky (UK) Chandler Medical Center between July 1, 2009 and June 30, 2011. The primary outcome was in-hospital mortality and the secondary outcomes were major adverse cardiovascular events, extent ofmyocardial injury, bleeding, and 4) length of stay. Patientswere analyzed by presenting facilityVtheUKhospital versus an outside hospital (OSH)Vand treatment strategy (PPCI vs fibrinolytic therapy). Further analyses assessed primary and secondary outcomes by treatment strategy within transfer distance and compliance with American Heart Association guidelines. Results: Patients presenting directly to the UK hospital had significantly shorter door-to-balloon times than those presenting to an OSH (83 vs 170 minutes; P G 0.001). This did not affect short-term mortality or secondary outcomes. By comparison, OSH patients treated with fibrinolytic therapy had a numeric reduction inmortality (4.0{\%}vs 12.3{\%}; P = 0.45). Overall, only 20{\%} of OSH patients received timely reperfusion, 13{\%} PPCI, and 42{\%} fibrinolytics. In a multivariable model, delayed reperfusion significantly predictedmajor adverse cardiovascular events (odds ratio 3.87, 95{\%} confidence interval 1.15Y13.0; P = 0.02), whereas the presenting institution did not. Conclusions: In contemporary treatment of STEMI in Kentucky, ongoing delays to reperfusion therapy remain regardless of treatment strategy. For further improvement in care, acceptance of transfer delays is necessary and institutions should adopt standardized protocols in association with a regional system of care.",
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T1 - Fibrinolytic therapy versus primary percutaneous coronary interventions for st-segment elevation myocardial infarction in kentucky

T2 - Time to establish systems of care?

AU - Wallace, Eric L.

AU - Kotter, John R.

AU - Charnigo, Richard

AU - Kuvlieva, Liliana B.

AU - Smyth, Susan S.

AU - Ziada, Khaled M.

AU - Campbell, Charles

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Y1 - 2013/7/1

N2 - Background: Fibrinolytic therapy is recommended for ST-segment myocardial infarctions (STEMI) when primary percutaneous coronary intervention (PPCI) is not available or cannot be performed in a timely manner. Despite this recommendation, patients often are transferred to PPCI centers with prolonged transfer times, leading to delayed reperfusion. Regional approaches have been developed with success and we sought to increase guideline compliance in Kentucky. Methods: A total of 191 consecutive STEMI patients presented to the University of Kentucky (UK) Chandler Medical Center between July 1, 2009 and June 30, 2011. The primary outcome was in-hospital mortality and the secondary outcomes were major adverse cardiovascular events, extent ofmyocardial injury, bleeding, and 4) length of stay. Patientswere analyzed by presenting facilityVtheUKhospital versus an outside hospital (OSH)Vand treatment strategy (PPCI vs fibrinolytic therapy). Further analyses assessed primary and secondary outcomes by treatment strategy within transfer distance and compliance with American Heart Association guidelines. Results: Patients presenting directly to the UK hospital had significantly shorter door-to-balloon times than those presenting to an OSH (83 vs 170 minutes; P G 0.001). This did not affect short-term mortality or secondary outcomes. By comparison, OSH patients treated with fibrinolytic therapy had a numeric reduction inmortality (4.0%vs 12.3%; P = 0.45). Overall, only 20% of OSH patients received timely reperfusion, 13% PPCI, and 42% fibrinolytics. In a multivariable model, delayed reperfusion significantly predictedmajor adverse cardiovascular events (odds ratio 3.87, 95% confidence interval 1.15Y13.0; P = 0.02), whereas the presenting institution did not. Conclusions: In contemporary treatment of STEMI in Kentucky, ongoing delays to reperfusion therapy remain regardless of treatment strategy. For further improvement in care, acceptance of transfer delays is necessary and institutions should adopt standardized protocols in association with a regional system of care.

AB - Background: Fibrinolytic therapy is recommended for ST-segment myocardial infarctions (STEMI) when primary percutaneous coronary intervention (PPCI) is not available or cannot be performed in a timely manner. Despite this recommendation, patients often are transferred to PPCI centers with prolonged transfer times, leading to delayed reperfusion. Regional approaches have been developed with success and we sought to increase guideline compliance in Kentucky. Methods: A total of 191 consecutive STEMI patients presented to the University of Kentucky (UK) Chandler Medical Center between July 1, 2009 and June 30, 2011. The primary outcome was in-hospital mortality and the secondary outcomes were major adverse cardiovascular events, extent ofmyocardial injury, bleeding, and 4) length of stay. Patientswere analyzed by presenting facilityVtheUKhospital versus an outside hospital (OSH)Vand treatment strategy (PPCI vs fibrinolytic therapy). Further analyses assessed primary and secondary outcomes by treatment strategy within transfer distance and compliance with American Heart Association guidelines. Results: Patients presenting directly to the UK hospital had significantly shorter door-to-balloon times than those presenting to an OSH (83 vs 170 minutes; P G 0.001). This did not affect short-term mortality or secondary outcomes. By comparison, OSH patients treated with fibrinolytic therapy had a numeric reduction inmortality (4.0%vs 12.3%; P = 0.45). Overall, only 20% of OSH patients received timely reperfusion, 13% PPCI, and 42% fibrinolytics. In a multivariable model, delayed reperfusion significantly predictedmajor adverse cardiovascular events (odds ratio 3.87, 95% confidence interval 1.15Y13.0; P = 0.02), whereas the presenting institution did not. Conclusions: In contemporary treatment of STEMI in Kentucky, ongoing delays to reperfusion therapy remain regardless of treatment strategy. For further improvement in care, acceptance of transfer delays is necessary and institutions should adopt standardized protocols in association with a regional system of care.

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