Impact of ECG Findings and Process-Of-Care Characteristics on the Likelihood of Not Receiving Reperfusion Therapy in Patients with ST-Elevation Myocardial Infarction: Results of a Field EvaluationReport as inadecuate




Impact of ECG Findings and Process-Of-Care Characteristics on the Likelihood of Not Receiving Reperfusion Therapy in Patients with ST-Elevation Myocardial Infarction: Results of a Field Evaluation - Download this document for free, or read online. Document in PDF available to download.

Background

Many patients with ST-elevation myocardial infarction STEMI do not receive reperfusion therapy and are known to have poorer outcomes. We aimed to perform the first population-level, integrated analysis of clinical, ECG and hospital characteristics associated with non-receipt of reperfusion therapy in patients with STEMI.

Methods and Results

This systematic evaluation of STEMI care in 82 hospitals in Quebec included all patients with a discharge diagnosis of myocardial infarction, presenting with characteristic symptoms and an ECG showing STEMI as attested by at least one of two study cardiologists or left bundle branch block LBBB. Excluding LBBB, an ECG was considered a definite STEMI diagnosis if both cardiologists scored ‘certain STEMI’ and ambiguous if one scored ‘uncertain’ or ‘not STEMI’. Centers were classified according to accessibility to primary percutaneous coronary intervention PPCI: 1 on-site PPCI; 2 routine transfer for PPCI; 3 varying mix of PPCI transfer and on-site fibrinolysis; and 4 routine on-site fibrinolysis. Of 3730 STEMI-LBBB patients, 812 21.8% did not receive reperfusion therapy. In multivariate analysis, likelihood of no reperfusion therapy was a function of PPCI accessibility odds ratio OR for fibrinolysis versus PPCI centers = 3.1; 95% CI: 2.2–4.4, presence of LBBB OR = 24.1; 95% CI: 17.8–32.9 and an ECG ambiguous for STEMI OR = 4.1; 95% CI: 3.3–5.1. When the ECG was ambiguous, likelihood of no reperfusion therapy was highest in hospitals most distant from PPCI centers.

Conclusions

ECG diagnostic ambiguity, LBBB and PPCI accessibility are important predictors of not receiving reperfusion therapy, suggesting opportunities for improving outcomes.



Author: Kevin A. Brown, Laurie J. Lambert , James M. Brophy, James Nasmith, Stéphane Rinfret, Eli Segal, Simon Kouz, Dave Ross, Richard

Source: http://plos.srce.hr/



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