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Title: Pre-hospital management of patients with ST- elevation myocardial infarction in Krakow agglomeration

Abstract:

Background: Acute coronary syndromes (ACS) are a major health problem in Poland and all over the world. Mortality in myocardial infarction depends on several factors, including the time and the type of treatment used. High density of intervention centers allows the use of new reperfusion therapy such as percutaneous coronary intervention (PCI). Diagnosis of myocardial infarction is possible dute to pre-hospital ECG and ECG teletransmission and it allows direct referral to the invasive cardiology center. Initial therapy including anti-platelet and anticoagulant medicines enables rapid treatment efficacy.Aim: To evaluate the pre-hospital management of patients with ST-elevation myocardial infarction and its effects on treatment results.Material and methods: The hospital and pre-hospital records of patients with ST-elevation myocardial infarction admitted to invasive cardiology centre since January 2011 until December 2015 (excluding 2013) were retrospectively reviewed. Study includes patients who were directly referred to the catheterization laboratory from the scene by emergency medical service (EMS) teams. The follow-up was done by phone calls to patients or their relatives if patient deceased. ; Results: Among 596 patients with STEMI referred by EMS 573 with data on time spent on scene available were enrolled. The median (IQR) time between when the patient called the ambulance and when he or she was referred to hospital was 59 (50-72) minutes A significant correlation was noted between an increase of first medical contact (FMC) time to hospital arrival and in-hospital mortality with a odds ratio (OR) of 1,022 for every minute of time delay (95% CI: 1,002-1,04). However it became statistically insignificant in multivariable regression. The median (IQR) FMC-to-PCI time was 87 (74-103) minutes. The European Society of Cardiology time recommendations on FMC-to-PCI time ≤90 minutes were met in 55,6% patients. Nonetheless only in 6,8% patients with symptom-onset time <2h where FMC-to-PCI time should not exceed 60 minutes. Among pre-hospital procedures the anti-platelet and anticoagulant therapy was associated with in-hospital mortality. The use of clopidogrel or heparin or both reduced in-hospital mortality rate (OR=0,32; 95% CI: 0,13-0,78). Clopidogrel aministration was associated with decreased risk of left ventricular ejection fraction (LVEF) measured before discharge (OR=0,27; 95% CI: 0,09-0,90). None of pre-hospital procedures was associated with mortality rate after discharge. The ECG teletransmission did not correlate in any way with reduction of time delays and did not affect LVEF nor mortality rate.Conclusions: Emergency medical service teams plays a significant role in treatment of STEMI patients. Prolonged pre-hospital management is associated with in-hospital mortality rate and effects left ventricular dysfunction at discharge. Pre-hospital drug administration reduces in-hospital mortality.

Place of publishing:

Kraków

Level of degree:

2 - studia doktoranckie

Degree discipline:

ratownictwo medyczne ; zdrowie publiczne

Degree grantor:

Uniwersytet Jagielloński. Collegium Medicum. Wydział Nauk o Zdrowiu.

Promoter:

Antoni Czupryna

Date issued:

2017

Format:

application/pdf

Identifier:

oai:dl.cm-uj.krakow.pl:4229

Call number:

ZB-127389

ControlNumberVIRTUA:

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Language:

pol

Access rights:

tylko w bibliotece

Location of original object:

Biblioteka Medyczna Uniwersytetu Jagiellońskiego- Collegium Medicum

Object collections:

Last modified:

May 24, 2021

In our library since:

Mar 20, 2018

Number of object content hits:

12

Number of object content views in PDF format

12

All available object's versions:

http://dl.cm-uj.krakow.pl:8080/publication/4230

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ZB-127389 May 24, 2021
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