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J. Clin. Med. 2019, 8(1), 78; https://doi.org/10.3390/jcm8010078

Annual Trends in Total Ischemic Time and One-Year Fatalities: The Paradox of STEMI Network Performance Assessment

1
2nd Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Katowice, Poland, M. Sklodowskiej-Curie Str. 10, 41-800 Zabrze, Poland
2
3rd Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Katowice, Silesian Centre for Heart Diseases in Zabrze, Poland, M. Sklodowksiej-Curie Str. 9, 41-800 Zabrze, Poland
3
Department of Cardiology, University Hospital, Faculty of Natural Sciences and Technology, University of Opole, Opole, Poland, Witosa Str. 26, 45-401 Opole, Poland
*
Author to whom correspondence should be addressed.
Received: 16 December 2018 / Revised: 3 January 2019 / Accepted: 6 January 2019 / Published: 11 January 2019
(This article belongs to the Section Cardiology)
Full-Text   |   PDF [998 KB, uploaded 11 January 2019]   |  

Abstract

This study is aimed at assessing trends and relations between total ischemic time, the major quality measure of systemic delay, and case-fatality at the population or patient level in response to growing cardiovascular risk and a constant need to shorten the time to treatment in ST-segment elevation myocardial infarction (STEMI). Data from a prospective nationwide registry of STEMI patients admitted between 2006 and 2013 who were treated with primary percutaneous coronary intervention (PCI) were analyzed. Total ischemic time was calculated as the time from the onset of symptoms to primary PCI and was determined as individual and annual. The primary end-point was one-year, all-cause case-fatality. Among the total 70,093 analyzed patients, temporal trends showed significant decrease in total ischemic time (268 vs. 230 minutes, p < 0.001), a worsening of the risk profile and an increase in one-year case-fatality (7.1% vs. 10.8%, p < 0.001). In the multivariate analysis, longer individual total ischemic time was a risk factor for higher mortality (HR 1.024, 95%CI 1.015–1.034, p < 0.001) and remained significant after adjustment for the year of admission. An inverse relation was observed for the median annual time (HR 0.992, 95%CI 0.989–0.994, p < 0.001). Thus, the observed increasing annual trends in case-fatality cannot directly measure the quality of STEMI network performance. View Full-Text
Keywords: total ischemic time; case-fatality; STEMI; network total ischemic time; case-fatality; STEMI; network
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MDPI and ACS Style

Kawecki, D.; Morawiec, B.; Gąsior, M.; Wilczek, K.; Nowalany-Kozielska, E.; Gierlotka, M. Annual Trends in Total Ischemic Time and One-Year Fatalities: The Paradox of STEMI Network Performance Assessment. J. Clin. Med. 2019, 8, 78.

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