Clinical Results of Acute ST Elevation Myocardial Infarction Patients with the Fast Tract Management System in Naresuan University Hospital

Khanittha Lairakdomrong; Suthasinee Thamaree; Ampai Tangsirirat

Authors

Khanittha Lairakdomrong Department of Medicine, Naresuan University Hospital, Phitsanulok, Thailand
Suthasinee Thamaree Department of Medicine, Naresuan University Hospital, Phitsanulok, Thailand
Ampai Tangsirirat Naresuan University Hospital, Phitsanulok, Thailand

Keywords:

ST elevation myocardial infarction, fast tract

Abstract

Background: Acute ST-elevation myocardial infarction (STEMI) is a life-threatening emergency cardiovascular condition. Mortality is still high in rural region.

Objective: to identify mortality rate and evaluate the clinical outcomes of acute STEMI patients using the fast tract management system at Naresuan University Hospital (NUH)

Material and Method: Descriptive review of clinical parameters from STEMI patients who participated in the fast tract management system

Results: Between Jan 2010 to Sep 2013, 191 STEMI patients were enrolled. The 147 patients (77%) were referrals and 44 patients (23%) were non-referrals. They were predominantly male patients with an average age of 65 years. The risk factors of coronary artery disease (CAD) were dyslipidemia (86.9%), hypertension (61.3%), smoking (51.3%) and diabetes mellitus (18.3%). Cardiac arrest was found in 16.2% and 14.1% presented with cardiogenic shock. 86.4% received reperfusion therapy with 37.2% got primary percutaneous coronary intervention (PCI). The median door to balloon time and door to needle time for non-referral patients were 89 and 58 minutes, respectively. The median time to treatment was 226 min in the thrombolytic group and 234 min in the primary PCI group. The overall mortality rate was 11.5% which was much lower than the previous data of NUH (33.3%). For the referred patients, the median first medical contact (FMC) to device time was 344 min. Mortality rate of primary PCI in referral group (17.9%) was higher than in non-referral group (6.3%).

Conclusion: The mortality rate at NUH is lower than before having established fast tract management system but still high as compare to standard of care. Fibrinolytic therapy is preferred for the treatment of choice at non-PCI capable hospital and PCI will be considered for failed fibrinolysis or presence of contraindication to fibrinolysis. Shortening of pain to treatment time by fast tract management system is the mainstay to improve survival in the patients who suffer from STEMI.

References

Aguirre, F. V., Varghese, J. J., Kelly, M. P., Lam, W., Lucore, C. L., Gill, J. B., et al. (2008). Rural interhospital transfer of ST-elevation myocardial infarction patients for percutaneous coronary revascularization: the stat heart program. Circulation, 117, 1145-1152.

Antman, E. M., Anbe, D. T., Armstrong, P. W., Bates, E. R., Green, L. A., Hand, M., et al. (2004). ACC/AHA guidelines for the management of patients with ST elevation myocardial infarction: a report of the American College of cardiology/American Heart Association Task Force on Practice Guidelines (Committee to revise the 1999 Guidelines for the Management of Patients with Acute Myocardial Infarction). Circulation, 110, e82-292.

Antman, E. M., Anbe, D. T., Armstrong, P. W., Bates, E. R., Green, L. A., Hand, M., et al. (2004). ACC/AHA guidelines for the management of patients with ST elevation myocardial infarction-executive summary. A report of the American College of cardiology/American Heart Association Task Force on Practice Guidelines (Committee to revise the 1999 Guidelines for the Management of Patients with Acute Myocardial Infarction). J Am Coll Cardiol, 44, 671-719.

Boersma, E., Mercado, N., Poldermans, D., Gardien, M., Vos, J., & Simoons, M. L. (2003). Acutemyocardial infarction. Lancet, 361, 847-885.

Greg, W. S. (2008). Angioplasty strategies in ST-segment-elevation myocardial infarction: Part II: Intervention after fibrinolytic therapy, integrated treatment recommendations and future directions. Circulation, 118, 552-566.

Henry, T. D., Sharkey, S. W., Burke, M. N., Chavez, I. J., Graham, K. J., Henry, C. R., et al. (2007). A regional system to provide timely access to percutaneous coronary intervention for ST-elevation myocardial infarction. Circulation, 116, 721-728.

Jollis, J. G., Roettig, M. L., Aluko, A. O., Anstrom, K. J., Applegate, R. J., Babb, J. D., et al. (2007). Implementation of a statewide system for coronary reperfusion for ST-segment elevation myocardial infarction. JAMA, 298, 2371-2380.

Kleinschmidt, K., & Brady, W. J. (2001). Acute coronary syndromes: an evidence-based review and outcome-optimizing guidelines for patients with and without procedural coronary intervention (PCI). Part III: fibrinolytic therapy, procedural coronary intervention, multi-modal approaches and medical prophylaxis with low molecular weight heparins. Hospital Medicine Consensus Reports. Atlanta, GA: American Health Consultants.

Patrick, T. O., Frederick, G. K., Donald, E. C., James, A. L., James, C. F., Barry, A. F., et al. (2013). 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation, 127, e362-425.

Ribichini, F., Ferrero, V., & Wijns, W. (2004). Reperfusion treatment of ST-elevation acute myocardial infarction. Prog Cardiovasc Dis, 47, 131-157.

Srimahachota, S., Kanjanavanit, R., Boonyaratave,j S., Boonsom, W., Veerakul, G., & Tresukosol, D. (2007). Demographic, management practices and in-hospital mortality of Thai acute coronary syndrome registry (TACSR): The difference from the western world. J Med Assoc Thai, 90(Suppl 1), 1-11.

Srimahachota, S., Boonyaratavej, S., Kanjanavanit, R., Sritara, P., Krittayaphong, R., Kunjara-Na-Ayudhya, R., et al. (2012). Thai registry in acute coronary syndrome (TRACS)-An extension phase of Thai acute coronary syndrome registry((TACS) group: Lower in-hospital mortality but still high mortality at one-year. J Med Assoc Thai, 95, 508-518.

Steg, P. G., Goldberg, R. J., Gore, R. J., Fox, K. A., Eagle, K. A., Flather, M. D., et al. (2002). Baseline characteristics, management practices, and in-hospital outcomes of patients hospitalized with acute coronary syndromes in the Global Registry of Acute Coronary Events (GRACE). Am J Cardiol, 90, 358-363.

Van de Werf, F. (2009). Year 2008 ESC ST-segment elevation myocardial infarction guidelines: implications for the interventional cardiologist-from evidence to recommendations and practice. Eur Heart J, 11, c31-c37.

Van de Werf, F., Bax, J., Betriu, A., Blomstrom-Lundqvist, C., Crea, F., Falk, V., et al. (2008). Management of acute myocardial infarction in patients presenting with persistent ST-segment elevation: the Task Force on the Management of ST-Segment Elevation Acute Myocardial Infarction of the European Society of Cardiology. Eur Heart J, 29, 2909-2945.

Zhang, Y., & Huo, Y. (2001). Early reperfusion strategy for acute myocardial infarction: a need for clinical implementation. Journal of Zhejiang University-SCIENCE B (Biomedicine and Biotechnology), 12, 629-632.