Diferencias regionales en la atención al IAMCEST en España. Datos del Registro de Código Infarto ACI-SEC

  1. Oriol Rodríguez-Leor 1
  2. Ana Belén Cid Álvarez 2
  3. Raúl Moreno Gómez 3
  4. Xavier Rosselló 4
  5. Soledad Ojeda 5
  6. Ana María Serrador Frutos 6
  7. Ramón López Palop 7
  8. Javier Martín Moreiras 8
  9. José R. Rumoroso Cuevas 9
  10. Angel Cequier Fillat 10
  11. Borja Ibáñez 11
  12. Ignacio Cruz González 8
  13. Rafael Romaguera Torres 10
  14. Sergio Raposeiras Roubín 12
  15. Armando Pérez de Prado 13
  1. 1 Institut del Cor, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España
  2. 2 Servicio de Cardiología, Hospital Clínico de Santiago de Compostela, Santiago de Compostela, A Coruña, España
  3. 3 Servicio de Cardiología, Hospital Universitario La Paz, Madrid, España
  4. 4 Servicio de Cardiología, Institut d’Investigació Sanitària Illes Balears (IdISBa), Hospital Universitari Son Espases, Palma de Mallorca, Islas Baleares, España
  5. 5 Servicio de Cardiología, Hospital Universitario Reina Sofía, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba, Córdoba, España
  6. 6 Servicio de Cardiología, Hospital Clínico de Valladolid, Valladolid, España
  7. 7 Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, España
  8. 8 Servicio de Cardiología, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, España
  9. 9 Servicio de Cardiología, Hospital de Galdakao-Usansolo, Galdakao, Vizcaya, España
  10. 10 Servicio de Cardiología, Hospital de Bellvitge - IDIBELL, Universitat de Barcelona, L’Hospitalet de Llobregat, Barcelona, España
  11. 11 Servicio de Cardiología, IIS-Hospital Universitario Fundación Jiménez Díaz, Madrid, España
  12. 12 Servicio de Cardiología, Hospital Universitario Álvaro Cunqueiro, Instituto de Investigación Sanitaria Galicia Sur, Vigo, Pontevedra, España
  13. 13 Servicio de Cardiología, Hospital de León, León, España
Montrer des affiliations +
Revue:
REC: Interventional Cardiology

ISSN: 2604-7276,  2604-7306

Année de publication: 2023

Volumen: 5

Número: 2

Pages: 118-128

Type: Article

DOI: 10.24875/RECIC.M22000360 DIALNET GOOGLE SCHOLAR lock_openDialnet editor

D'autres publications dans: REC: Interventional Cardiology

Résumé

Introduction and objectives: Geographical and organizational differences between different autonomous communities (AC) can generate differences in care for ST-segment elevation myocardial infarction (STEMI). A total of 17 heart attack code programs have been compared in terms of incidence rate, clinical characteristics, reperfusion therapy, delay to reperfusion, and 30-day mortality. Methods: National prospective observational study (83 centers included in 17 infarction networks). The recruitment period was 3 months (April 1 to June 30, 2019) with clinical follow-up at 30 days. Results: 4366 patients with STEMI were included. The incidence rate was variable between different AC (P < .0001), as was gender (P = .003) and the prevalence of cardiovascular risk factors (P < .0001). Reperfusion treatment was primary angioplasty (range 77.5%-97.8%), fibrinolysis (range 0%-12.9%) or no treatment (range 2.2%- 13.5%). The analysis of the delay to reperfusion showed significant differences (P < .001) for all the intervals analyzed. There were significant differences in 30-days mortality that disappeared after adjusting for clinical and healthcare network characteristics. Conclusions: Large differences in STEMI care have been detected between the different AC, in terms of incidence rate, clinical characteristics, reperfusion treatment, delay until reperfusion, and 30-day mortality. The differences in mortality disappeared after adjusting for the characteristics of the patient and the care network.

Références bibliographiques

  • 1. Ibañez B, James S, Agewall S, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology. Eur Heart J. 2018;39:39:119-177.
  • 2. Cequier A, Pérez de Prado A, Cid-Álvarez AB, et al. Requisitos y sostenibilidad de los programas de ICP primaria en España en el IAMCEST. Documento de consenso de SEC, AEEC y SEMES. REC Interv Cardiol. 2019;1:108-119.
  • 3. Ojeda S, Romaguera R, Cruz-González I, Moreno R. Registro español de hemodinámica y cardiología intervencionista. XXIX Informe Oficial de la Asociación de Cardiología Intervencionista de la Sociedad Española de Cardiología (1990-2019). Rev Esp Cardiol. 2020;73:927-936.
  • 4. Rodríguez-Leor O, Cid-Álvarez AB, Pérez de Prado A, et al. Análisis de la atención al infarto con elevación del segmento ST en España. Resultados del Registro de Código Infarto de la ACI-SEC. Rev Esp Cardiol. 2022;75:669-680.
  • 5. Rodríguez-Leor O, Cid-Álvarez AB, Moreno R, et al. Encuesta sobre las necesidades de los programas de angioplastia primaria en España. REC Interv Cardiol. 2020;1:8-14.
  • 6. Instituto Nacional de Estadística. Datos de población de comunidades autónomas. Disponible en: https://www.ine.es/jaxiT3/Datos.htm?t=2915#!tabs-tabla. Consultado 24 Ene 2022.
  • 7. Bueno H, Rosselló X, Pocock SJ, et al. In-hospital coronary revascularization rates and post-discharge mortality risk in non-ST-segment elevation acute coronary syndrome. J Am Coll Cardiol. 2019;74:1454-1461.
  • 8. Rosselló X, Huo Y, Pocock S, et al. Global geographical variations in ST-segment elevation myocardial infarction management and post-discharge mortality. Int J Cardiol. 2017;245:27-34.
  • 9. Bueno H, Rosselló X, Pocock S, et al. Regional variations in hospital management and post-discharge mortality in patients with non-ST-segment elevation acute coronary syndrome. Clin Res Cardiol. 2018;107:836-844.
  • 10. Alter DA, Austin PC, Tu JV, et al. Canadian cardiovascular outcomes research. Community factors, hospital characteristics and inter-regional outcome variations following acute myocardial infarction in Canada. Can J Cardiol. 2005;21:247-255.
  • 11. Bertomeu V, Cequier A, Bernal JL, et al. In-hospital mortality due to acute myocardial infarction. Relevance of type of hospital and care provided. RECALCAR study. Rev Esp Cardiol. 2013:66:935-942.
  • 12. Moreno R, Ojeda S, Romaguera R, et al. Actualización de las recomendaciones sobre requisitos y equipamiento en cardiología intervencionista. Documento de consenso de la Asociación de Cardiología Intervencionista y la Asociación de Cardiopatía Isquémica y Cuidados Agudos Cardiovasculares de la Sociedad Española de Cardiología y la Asociación Española de Enfermería en Cardiología. REC Interv Cardiol. 2021;3:33-44.
  • 13. Carrillo X, Fernandez-Nofrerias E, Rodriguez-Leor O, et al. Early ST elevation myocardial infarction in on-capable percutaneous coronary intervention centres: in situ fibrinolysis vs. percutaneous coronary intervention transfer. Eur Heart J. 2016;37:1034-1040.
  • 14. Terkelsen CJ, Sorensen JT, Maeng M, et al. System delay and mortality among patients with STEMI treated with primary percutaneous coronary intervention. JAMA. 2010;304:763-771.
  • 15. Rodríguez-Leor O, Fernández-Nofrerías E, Mauri F, et al. Analysis of reperfusion delay in patients with acute myocardial infarction treated with primary angioplasty based on first medical contact and time of presentation. Rev Esp Cardiol. 2011;64:476-483.
  • 16. Rodríguez-Leor O, Fernández-Nofrerías E, Mauri J, et al. Integration of a local into regional primary angioplasty action plan (the Catalan Codi Infart network) reduces time to reperfusion. Int J Cardiol. 2013;168:4354-4357.
  • 17. Bagai A, Jollis JG, Dauerman HL, et al. Emergency department bypass for ST-segment-elevation myocardial infarction patients identified with a prehospital electrocardiogram: a report from the American Heart Association Mission: Lifeline program. Circulation. 2013;128:352-359.
  • 18. Cequier A, Ariza-Sole A, Elola FJ, et al. Impacto en la mortalidad de diferentes sistemas de asistencia en red para el tratamiento del infarto agudo de miocardio con elevación del segmento ST. La experiencia de España. Rev Esp Cardiol. 2017;70:155-161.
  • 19. Sánchez-Salado JC, Burgos V, Ariza-Solé A, et al. Trends in cardiogenic shock management and prognostic impact of type of treating center. Rev Esp Cardiol. 2020;73:546-553.
  • 20. Rodríguez-Leor O, Cid-Álvarez AB, Pérez de Prado A, et al. Impact of COVID-19 on ST-segment elevation myocardial infarction care. The Spanish experience. Rev Esp Cardiol. 2020;73:994-1002.
La source de données: Dialnet