Regional variations of reperfusion strategy in patients with ST elevation myocardial infarction

• Dzhinibalaeva Zh.V.
• Mullova I.S.
• Timur V. Kislukhin
• Gorokhov A.A.
• Prozhoga M.G.
• Posnenkova O.M.
• Kiselev A.R.
• Duplyakov Dmitriy V.
• Khokhlunov S.M.

Abstract

The aim of the study was to analyze features of reperfusion strategy in patients with ST segment elevation myocardial infarction (STEMI) in the Samara Region.

Material and methods. Patients with acute coronary syndrome with ST-segment elevation (n=164) were included in the study, who underwent thrombolytic therapy at the prehospital stage during the period from 10.01.2014 to 12.24.2014. For further analysis data from 9 patients (5.5%) were excluded from the general group (164 patients), because acute coronary syndrome with ST-segment elevation diagnosis was not confirmed at the hospital stage. The 1^st group consisted of patients with acute coronary syndrome with ST-segment elevation who received only thrombolytic therapy at the prehospital stage (n=61), 2^nd group (n=94) consisted of patients with acute coronary syndrome with ST-segment elevation, who subsequently underwent Percutaneous Coronary Intervention (PCI) after receiving thrombolytic therapy at the prehospital stage.

Results. Patient data from both groups significantly differed only in clopidogrel usage frequency at EMS stage. This medical product received 88% of patients in PCI group and only 65% of patients in group without PCI. Patients who were hospitalized in PCI-centers, sought medical help almost 30 min earlier (time pain-call EMS). In the majority of patients (70% in non-PCI group and 75% in PCI group) thrombolytic therapy at the prehospital stage was performed within the first 3 h after onset of an anginal attack. According to ECG, coronary artery reperfusion rate 90 min after thrombolytic therapy at the prehospital stage was 90% in non-PCI group and 35.4% in PCI group. The PCI procedure was performed on average for 273 min from the moment of admission, which was accompanied by nearly twofold mortality decrease (5.3 versus 11.5%). Only heart failure severity according to Killip and anterior wall infarction significantly influenced the lethal outcome risk.

Conclusion. The conducted analysis showed high frequency of correct decision-making on conducting thrombolytic therapy at the prehospital stage by EMS feldsher's brigades among others. For the purpose of reduce the time to seek medical help it is necessary to develop regional social advertising. Further reduction of hospital mortality from acute coronary syndrome with ST-segment elevation is possible in case of direct hospitalization of this group of patients to the nearest PCI centers.

Keywords:myocardial infarction, primary angioplasty, thrombolysis, regional network

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