The importance of organizational variables in treatment time for patients with ST-elevation acute myocardial infarction improve delays in STEMI

Background: The time between arrival at the emergency department (ED) and balloon (D2B) in STEMI is one of the best indicators of the quality of care. Our aim is to describe treatment times and evaluate the causes of delay. Methods: This is an observational retrospective study, including all consecutive STEMI code patients ≥18 years old treated in the ED from 2013 to 2016.All the patients were stratified into two groups: delayed group with D2B > 70 min and non-delayed ≤70. The primary variable was D2B time. Findings: In total 327 patients were included, stratified according to their D2B as follows: 166 (67·48%) in the delayed group and 80 (32·52%) in the non-delayed group. The delayed group was older (p = 0·005), with more females (p = 0·060) and more atypical electrocardiogram (ECG) STEMI signs or symptoms (p = 0·058) (p = 0·087). Predictors of shorter D2B time were: typical STEMI ECG signs and short training sessions for nurses on identifying STEMI patients. Interpretation: There are delays particularly in specific groups with atypical clinical presentations. Short training sessions aimed at emergency nurses correlate with shorter delay. This suggests that continuing training for emergency nurses, along with organizational strategies, can contribute to increasing the quality of care. Clinical trial number: NCT0433338

Factores clínicos predictores de retraso en la actuación del código infarto

Introduction: Primary angioplasty (PA) is the treatment of choice in ST-segment elevation acute myocardial infarction (STEMI), provided that a delay of less than 120 minutes between the rst medical contact (FMC) and the opening of the artery is ensured. The time factor in relation to survival, prognosis and size of the infarction is vital. The aim was to describe time intervals until reperfusion and to evaluate delays in accordance with socio-demographic and clinical factors as predictors of acute myocardial infarction (AMI). Material and method: This is an observational, analytical and retrospective study in which patients activated with an AMI code at the emergency department of our center were consecutively included. Socio-demographic and clinical aspects, intervention delay times and mortality were evaluated. Results: 158 patients with a mean age of 64 years were included. 78% of patients were male and primary angioplasty was performed in 72% of them. The mortality rate was 3.5%, the median time FMC-opening of the artery was 107 minutes and the time onset of pain-reperfusion was 221 minutes. Women show a higher incidence of atypical pain: abdominal (p=0.006), scapular (p=0.009), of the back (p=0.001) and unspecic (p=0.026), and associated symptomatology: nausea and vomiting (p=0.053) and malaise (p=0.001). Also, there is a longer delay between electrocardiogram (ECG) and activation (p=0.006). Diabetics have a higher incidence of dyspnea (p=0.014) and mandibular pain (p=0.019). ECG-activation (p=0.002) and FMC-balloon (p<0.001) intervals increase in advanced age. Conclusions: Improvements should be made in order to reduce reperfusion time and for the early detection of AMI, taking into account the atypical and unspecic clinical characteristics of women and diabetics.Introducción: La angioplastia primaria (AP) es el tratamiento de elección en el infarto agudo de miocardio con elevación del ST siempre que se asegure un tiempo inferior a 120 minutos entre el primer contacto médico (PCM) y la apertura de la arteria. El factor tiempo en relación a supervivencia, pronóstico y tamaño del infarto es vital. El objetivo fue describir los intervalos de tiempo hasta la reperfusión y evaluar retrasos según factores sociodemográ„cos y clínicos predictores de infarto agudo de miocardio (IAM). Material y Método: Estudio observacional, analítico y retrospectivo en el que se incluyeron consecutivamente los pacientes activados cómo código IAM desde urgencias de nuestro centro. Se evaluaron aspectos sociodemográ„cos, clínicos, tiempos de actuación y mortalidad. Resultados: Se incluyeron 158 pacientes con edad media de 64 años. El 78% eran varones y se realizó angioplastia primaria al 72%. La mortalidad fue del 3,5%, la mediana de tiempo PCM-apertura arteria fue 107 minutos y el tiempo inicio dolor-reperfusión 221 minutos. Las mujeres presentan mayor incidencia de dolores atípicos: abdominal (P=0,006), escapular (p=0,009), espalda (p=0,001) e inespecí„cos (p=0,026) y sintomatología asociada: náuseas y vómitos (p=0,053) y malestar general (p=0,001). También mayor retraso entre electrocardiograma (ECG) y activación (p=0,006). Los diabéticos presentan mayor incidencia de disnea (p=0,014) y dolor mandibular (p=0,019). La edad avanzada aumenta los intervalos ECGActivación (p=0,002) y PCM-Balón (p<0,001). Conclusiones: Se deben realizar acciones de mejora para disminuir el tiempo de reperfusión y detectar precozmente el IAM, teniendo en cuenta la clínica atípica e inespecí„ca de mujeres y diabéticos

Complicaciones vasculares en el paciente sometido a procedimientos cardiovasculares percutáneos

• Introduction: Percutaneous cardiovascular procedures are a key tool for the assessment and treatment of a patient with coronary artery disease. Nevertheless, they bring about a risk of vascular complications occasionally requiring intervention, thereby leading to an increase in morbidity and costs and to an extension of the stay in hospital. • Materials and methods: Observational and prospective study, consecutively including 308 patients involving 363 vascular events. Demographic, clinical and procedure-related aspects, as well as the vascular complication rate, were evaluated. • Objective: Detecting the vascular complication rate after the percutaneous cardiac intervention following introduction of a new protocol in our centre. • Results: 63% of patients were catheterized through the radial artery and 30% through the femoral artery. Major complications were seen in 3.3% and minor complications were seen in 8% of them.Femoral access shows a higher rate of major complications as compared to radial access (p=0.042); they are more likely to appear with the use of introducers with a French size of greater than or equal to 7 (p=0.014). Women and short people show more major complications (p=0.012 and p=0.025, respectively). There is a higher incidence of minor complications when the catheter is not removed at the haemodynamics lab (p=0.040) • Conclusions: From the study results, use of radial access and vascular introducers smaller than 7 French is recommended in order to minimize vascular complications, especially in women and short people. It is further recommendable to apply the haemostatic techniques at the haemodynamics lab.• Introducción: Los procedimientos cardiovasculares percutáneos son una herramienta fundamental en la valoración y tratamiento del enfermo coronario. Sin embargo, conllevan riesgo de complicaciones vasculares que en ocasiones precisan de intervenciones motivando un aumento de morbilidad, costes y prolongación de estancia hospitalaria. • Material y método: Estudio observacional y prospectivo en el que se incluyeron 308 pacientes consecutivamente con 363 accesos vasculares. Se evaluaron aspectos demográficos, clínicos y relacionados con el procedimiento; y la tasa de complicaciones vasculares. • Objetivo: Detectar la incidencia de complicaciones vasculares posintervencionismo cardiaco percutáneo tras la introducción de un protocolo nuevo en nuestro centro. • Resultados: En el 63% de pacientes se realizó cateterismo por la arteria radial y un 30% femoral. Un 3,3% presentó complicaciones mayores y un 8,8% complicaciones menores. El acceso femoral en relación con el radial tiene más complicaciones mayores (p=0,042); también aumenta las posibilidades de éstas el uso de introductores de mayor o igual calibre a 7 french (p=0,014). Las mujeres y las personas de estatura baja presentan más complicaciones mayores (p=0,012 y p=0,025 respectivamente). Existe mayor incidencia de complicaciones menores cuando la retirada del acceso no tiene lugar en el laboratorio de hemodinámica (p=0,040). • Conclusiones: Según resultados del estudio se aconseja el uso del acceso radial e introductores vasculares inferiores a 7 french para minimizar las complicaciones vasculares, sobre todo en mujeres y pacientes de estatura baja. También, es recomendable aplicar las técnicas de hemostasia en el laboratorio de hemodinámica