Patient and system delays in the treatment of acute coronary syndrome

Autores da FMUP

• Carla Alexandra Rodrigues Araújo

  Autor

• Ana Isabel Correia Ribeiro

  Autor

• Maria Júlia Pires Maciel Barbosa

  Autor

• Nuno Miguel De Sousa Lunet

  Autor

• Ana Azevedo Cardoso Oliveira

  Autor

Participantes de fora da FMUP

• Viana, M
• Laszczynska, O
• Borges, A
• Barros, V
• Dias, P
• Moreira, I

Unidades de investigação

• Ciências da Saúde Pública e Forenses, e Educação Médica

Abstract

Introduction: Early reperfusion for patients with ST-segment elevation myocardial infarction (STEMI) is indicated by the European Society of Cardiology, while a timely invasive strategy is recommended for patients with high-risk and intermediate-risk non-ST-elevation acute coronary syndromes (NSTE-ACS). This study aims to assess patient and system delays according to diagnosis and risk profile, and to identify predictors of prolonged delay. Methods: We assembled a cohort of patients (n=939) consecutively admitted to the cardiology department of two hospitals, one in the metropolitan area of Porto and one in the north-east region of Portugal, between August 2013 and December 2014. Results: The proportion of patients with time from symptom onset to first medical contact (FMC) >= 120 min was highest among high-risk NSTE-ACS (57.7%), followed by intermediate-risk NSTE-ACS (52.1%) and STEMI (43.3%). Regardless of diagnosis and risk stratification, use of own transportation and inability to interpret cardiac symptoms correctly were associated with prolonged delays. Regarding system delays, we found that 78.0% of patients with STEMI and 65.8% of patients with high-risk NSTE-ACS were treated in a timeframe exceeding the recommended limits. Admission to a non-percutaneous coronary intervention-capable hospital, admission on weekends and complications at admission were associated with prolonged delays to treatment. Conclusions: Due to both patient and system delays, a large proportion of STEMI and high-risk NSTE-ACS patients still fail to have access to timely reperfusion. (C) 2020 Sociedade Portuguesa de Cardiologia. Published by Elsevier Espana, S.L.U.

Keywords

• Acute coronary syndrome; ST-segment elevation myocardial infarction; Non-ST-elevation acute coronary syndromes; Patient delays; System delays