Decade-long trends in the timeliness of receipt of a primary percutaneous coronary intervention

Clinical Epidemiology Dovepress open access to scientific and medical research ORIGINAL RESEARCH Open Access Full Text Article Clinical Epidemiology downloaded from https://www.dovepress.com/ by 83.202.244.141 on 07-Jul-2020 For personal use only. Decade-long trends in the timeliness of receipt of a primary percutaneous coronary intervention This article was published in the following Dove Press journal: Clinical Epidemiology 6 June 2016 Number of times this article has been viewed Han-Yang Chen 1 Joel M Gore 1,2 Kate L Lapane 1 Jorge Yarzebski 1 Sharina D Person 1 Catarina I Kiefe 1 Robert J Goldberg 1,3 1 Department of Quantitative Health Sciences, 2Department of Medicine, 3 Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester, MA, USA Objectives: The purpose of this study was to examine decade-long trends (2001–2011) in, and factors associated with, door-to-balloon time within 90 minutes of hospital presentation among patients hospitalized with ST-segment elevation myocardial infarction (STEMI) who received a primary percutaneous coronary intervention (PCI). Methods: Residents of central Massachusetts hospitalized with STEMI who received a primary PCI at two major PCI-capable medical centers in central Massachusetts on a biennial basis between 2001 and 2011 comprised the study population (n=629). Multivariable regression analyses were used to examine factors associated with failing to receive a primary PCI within 90 minutes after emergency department (ED) arrival. Results: The average age of this patient population was 61.9 years; 30.5% were women, and 91.7% were White. During the years under study, 50.9% of patients received a primary PCI within 90 minutes of ED arrival; this proportion increased from 2001/2003 (17.2%) to 2009/2011 (70.5%) (P<0.001). Having previously undergone coronary artery bypass graft surgery, arriving at the ED by car/walk-in and during off-hours were significantly associated with a higher risk of failing to receive a primary PCI within 90 minutes of ED arrival. Conclusion: The likelihood of receiving a timely primary PCI in residents of central Massachusetts hospitalized with STEMI at the major teaching/community medical centers increased dramatically during the years under study. Several groups were identified for purposes of heightened surveillance and intervention efforts to reduce the likelihood of failing to receive a timely primary PCI among patients acutely diagnosed with STEMI. Keywords: epidemiology, ST-segment elevation myocardial infarction, percutaneous coronary intervention Introduction Correspondence: Robert J Goldberg Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA 01605, USA Tel +1 508 856 3991 Fax +1 508 856 8993 Email 141 submit your manuscript | www.dovepress.com Clinical Epidemiology 2016:8 141–149 Dovepress © 2016 Chen et al. This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms. php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php). http://dx.doi.org/10.2147/CLEP.S102225 Powered by TCPDF (www.tcpdf.org) The prompt administration of coronary reperfusion therapy for patients with an evolving acute myocardial infarction (AMI) is crucial in reducing mortality and the risk of serious clinical complications in these patients.1 During the past decade, primary percutaneous coronary intervention (PCI) has gradually replaced thrombolysis as the main revascularization strategy for patients presenting with ST-segment elevation myocardial infarction (STEMI), since primary PCI has been found to be superior to thrombolytic therapy when performed rapidly by expert teams.2 Because the effectiveness of primary PCI may be limited by delays in its prompt delivery, current clinical guidelines have recommended a door-to-balloon time of 90 minutes or less for patients hospitalized with STEMI who undergo a primary PCI.1 Dovepress Clinical Epidemiology downloaded from https://www.dovepress.com/ by 83.202.244.141 on 07-Jul-2020 For personal use only. Chen et al To date, while a number of studies have described the timing of receipt of a PCI in patients presenting to the hospital with STEMI, there are little population-based data available describing contemporary trends in the magnitude of, and factors associated with, door-to-balloon times in patients experiencing STEMI who receive a primary PCI;3–6 the limited studies in this area have shown mixed results of improvement in door-to-balloon time during varying study years and an inconsistent profile of patients who fail to be treated within recommended guidelines.3–6 Inasmuch, there is a need to examine relatively contemporary long-term trends in the extent of, and potential risk factors associated with, delays in door-to-balloon time among patients hospitalized with STEMI who undergo a primary PCI, particularly from the more generalizable perspective of a population-based investigation. The primary objective of our study was to describe decade-long (2001–2011) trends in the extent of delay from hospital emergency department (ED) presentation to initiation of primary PCI among patients hospitalized with STEMI. Our secondary objective was to examine factors associated with the failure to receive a primary PCI within 90 minutes after ED arrival among patients hospitalized with STEMI. Data from the Worcester Heart Attack Study were used for purposes of this investigation.7–10 Methods Described elsewhere in detail,7–10 the Worcester Heart Attack Study is an ongoing population-based investigation examining long-term trends in the descriptive epidemiology of AMI in residents of the Worcester, MA, metropolitan area (2000 census =478,000) hospitalized at all eleven medical centers in central Massachusetts on an approximate biennial basis between 1975 and 2011.7–10 We reviewed patient’s medical records on an approximate biennial basis since the inception of this study due to the availability of federal funding support and design features of this observational study. Computerized printouts of patients discharged from all greater Worcester hospitals with possible AMI (International Classification of Disease (ninth revision) codes: 410–414, 786.5) were identified. Cases of possible AMI were independently validated using predefined criteria for AMI;7–10 these criteria included a suggestive clinical (...truncated)