Clinical Research - Coronary Artery Disease ManagementBridging the Gap for Nonmetropolitan STEMI Patients Through Implementation of a Pharmacoinvasive Reperfusion Strategy
Section snippets
Geographical data
Alberta, Canada covers an area of 661,848 m2 with an estimated population of 3.7 million. For the purposes of this study, the 5 centres in metropolitan Edmonton with 2 primary PCI centres were considered to be metropolitan, and the remainder of Central and Northern Alberta referral area were considered nonmetropolitan. The estimated catchment area for the population in this study is approximately 440,000 km2 serving 1.8 million inhabitants.
Prehospital care
Vital Heart Response (VHR) is a regional reperfusion
Patient characteristics
Over a 5-year period, 1990 and 1602 STEMI patients were recruited from the metropolitan and nonmetropolitan pools respectively. Baseline patient characteristics are presented in Table 1. The nonmetropolitan population was younger, and on FMC, had higher heart rates compared with the urban group. Metropolitan patients had a higher proportion of traditional cardiovascular risk factors, with more pre-existing coronary artery disease (CAD) and chronic aspirin use, hypercholesterolemia,
Discussion
This study is distinct in providing real world information about outcome of STEMI patients with an index presentation either to a metropolitan or nonmetropolitan facility in Canada. It attempts to compare outcomes of patients first presenting at geographically distinct (metropolitan and nonmetropolitan) facilities within an organized system of care, with protocols directed at shortening delays for an optimal reperfusion strategy. With the majority of nonmetropolitan patients receiving a
Conclusion
STEMI patients presenting to nonmetropolitan facilities receiving a pharmacoinvasive reperfusion approach within an organized system of care do not appear to be exposed to an increased risk of adverse clinical outcomes, and seems an equally safe and effective strategy, compared with metropolitan patients principally receiving primary PCI. Despite this, substantial reperfusion delay occurs in nonmetropolitan patients and efforts to reduce this are required to further improve clinical outcomes.
Acknowledgements
The authors acknowledge the VHR clinicians (Drs R. Leung, B. Tyrrell) and the staff at the Epidemiology Coordinating and Research Centre at the University of Alberta for their dedication to quality data.
References (16)
- et al.
Assessment and management of acute coronary syndromes (ACS): a Canadian perspective on current guideline-recommended treatment–part 2: ST-segment elevation myocardial infarction
Can J Cardiol
(2011) - et al.
Canadian Cardiovascular Society Working Group: providing a perspective on the 2007 focused update of the American College of Cardiology and American Heart Association 2004 guidelines for the management of ST elevation myocardial infarction
Can J Cardiol
(2009) - et al.
The ideal reperfusion strategy for the ST-segment elevation myocardial infarction patient with expected delay to percutaneous coronary intervention: paradise lost or paradise renamed?
JACC Cardiovasc Interv
(2009) - et al.
Time-to-reperfusion in patients undergoing interhospital transfer for primary percutaneous coronary intervention in the U.S.: an analysis of 2005 and 2006 data from the National Cardiovascular Data Registry
J Am Coll Cardiol
(2008) - et al.
Efficacy and safety of immediate angioplasty versus ischemia-guided management after thrombolysis in acute myocardial infarction in areas with very long transfer distances results of the NORDISTEMI (NORwegian study on DIstrict treatment of ST-elevation myocardial infarction)
J Am Coll Cardiol
(2010) - et al.
Combined angioplasty and pharmacological intervention versus thrombolysis alone in acute myocardial infarction (CAPITAL AMI study)
J Am Coll Cardiol
(2005) - et al.
Duration of symptoms is the key modulator of the choice of reperfusion for ST-elevation myocardial infarction
Circulation
(2009) - et al.
2009 Focused Updates: ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction (updating the 2004 Guideline and 2007 Focused Update) and ACC/AHA/SCAI Guidelines on Percutaneous Coronary Intervention (updating the 2005 Guideline and 2007 Focused Update): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines
Circulation
(2009)
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