RT Journal Article
SR Electronic
T1 Providing optimal regional care for ST-segment elevation myocardial infarction: a prospective cohort study of patients in the Hamilton Niagara Haldimand Brant Local Health Integration Network
JF CMAJ Open
FD Canadian Medical Association
SP E1
OP E7
DO 10.9778/cmajo.20140035
VO 3
IS 1
A1 Mathew Mercuri
A1 Michelle Welsford
A1 Jon-David Schwalm
A1 Shamir R Mehta
A1 Purnima Rao-Melacini
A1 Nicholas Valettas MD MASc
A1 Tej Sheth
A1 Michael Rokoss
A1 Sanjit S. Jolly
A1 James L. Velianou
A1 Madhu K. Natarajan
YR 2015
UL http://www.cmajopen.ca/content/3/1/E1.abstract
AB Background Although considered the evidence-based best therapy for ST-segment elevation myocardial infarction (STEMI), many patients do not receive primary percutaneous coronary intervention (PCI) because of health care resource distribution and constraints. This study describes the clinical management and outcomes of all patients identified with STEMI within a region, including those who did not receive primary PCI. Methods This study used a prospective cohort design. Patients presenting with STEMI to PCI- and non−PCI-capable hospitals in one integrated health region in Ontario were included in the study. The primary objective was to examine use of reperfusion strategies and timeliness of care. Secondary objectives included determining (through regression models) which variables were associated with mortality within 90 days, and describing patient uptake of risk-reducing therapies and activities post-STEMI. Results Between Apr. 1, 2010, and Mar. 31, 2013, data were collected on 2247 consecutive patients presenting with STEMI. Patients presenting to the PCI-capable hospital were more likely to receive primary PCI (82.5% v. 65.2%, p < 0.001) and be treated within optimal treatment times. However, there was no appreciable difference in mortality at 90 days post-STEMI between patients presenting to PCI- and non−PCI-capable hospitals (7.8% v. 7.5%, p = 0.82), even after adjustment for acuity on presentation. Despite recognized risk factors, many patients were not taking evidence-based medications for risk factor modification before STEMI. Interpretation A systematic approach to regional STEMI care focusing on timely access to the best available therapies, rather than the type of reperfusion provided alone, can yield favourable outcomes.