학술논문
Abstract P210: Long-Term Outcomes After ST-Elevation Myocardial Infraction After Reducing Fibrinolytic Use in a Rural Cohort
Document Type
Article
Author
Source
Circulation (Ovid); March 2019, Vol. 139 Issue: Supplement 1 pAP210-AP210, 1p
Subject
Language
ISSN
00097322; 15244539
Abstract
Background:ST-elevation myocardial infarction (STEMI) guidelines recommend lytic therapy if unable to receive primary percutaneous coronary intervention (PPCI) within 120 min. from first medical contact (FMC). Sparse data exists from rural areas; we aimed to evaluate outcomes in rural population after implementing STEMI protocol.Methods:Retrospective chart review of NCDR ACTION and internal STEMI registries presenting to 2 PCI-capable hospitals (Essentia Health in Duluth, MN and Fargo, ND) between 5/2009-12/2017. Only patients with rural rural-urban commuting area (RUCA) codes were included. Analysis included using standard STEMI metrics with Cox regression and Kaplan-Meier survival curves for survival analysis, and logistic regression for 30-day and 1-year mortality and 30-day readmission. Results were adjusted for age and sex.Results:There were 1229 STEMI activations with 1033 true STEMI events (28.3% female, mean age 63.6 years). Among true STEMIs, 73.3% presented to a non-PCI capable hospital and were transferred to PCI-capable hospital. Only 9.9% were field activated and transported directly to PCI-capable hospital. FMC to device time was <120 min. 33.2% of the time with a median FMC to device time of 135 min. (IQR 111-174 min.). Positive ECG to device time was <120 min. 53.9% of the time with a median ECG to device time of 116 min. (IQR 99-144 min). Lytic use decreased over time from 30.2% in 2009-10 to 6.8% in 2016-17. Survival was not different comparing PPCI vs. lytic therapy (hazard ratio 1.21; 95% CI: 0.83, 1.75, p=0.32). For PPCI, 30-day and 1-year mortality were 8.6% (CI:6.8%-10.4%) and 12.8% (CI:10.6%-15.0%), respectively, while for lytics, 30-day and 1-year mortality were 7.2% (CI:4.6%-9.8%) and 10.8% (CI:7.1%-14.3%), respectively. The 30-day readmission for PPCI was not significantly different compared to lytics (7.6%, CI:6.7%-8.7% for PPCI vs. 12.0% CI:9.8%-14.6% for lytic, p=0.056).Conclusion:PPCI in rural areas was associated with similar outcomes compared to lytic therapy for STEMI patients.