AsianScientist (Apr. 27, 2011) – In large, traffic-congested Shanghai, China, severe heart attack patients received treatment faster and had better long-term results when interventional physicians were brought to them, according to a study published in Circulation: Cardiovascular Quality and Outcomes.
The REVERSE-STEMI study involved 334 patients who had suffered a ST elevation myocardial infarction (STEMI), a severe form of heart attack.
The patients were initially brought to one of five hospitals, all in Shanghai, China, that didn’t have specialists who could perform primary percutaneous coronary infusion (PPCI) or primary angioplasty, but had cardiac catheterization laboratories.
In this study, half of the patients were transferred to a sixth hospital capable of performing PPCI – the routine procedure. The other half were subject to an “interventionalist-transfer strategy”, where they stayed put while an interventional cardiologist was dispatched over.
They tracked the “door-to-balloon time”, the period between the patient’s arrival to getting an angioplasty. The goal is a door-to-balloon time of 90 minutes or less.
About 21 percent of the patients in the interventionalist-transfer group had PPCI performed within the 90 minute time frame, compared with just 7.7 percent of those in the patient-transfer group.
Traffic increased the door-to-balloon times by delaying both the arrival at the first hospital and transfer to the second hospital. The average transfer distance was 17.5 kilometers (almost 11 miles).
One year later, 85 percent of the interventionalist-transfer group had not experienced any other major cardiac events, such as another heart attack, compared to nearly 75 percent of the patient transfer group.
Also a year later, the left ventricular ejection fraction of patients in the interventionalist-transfer group (60.1 percent) was significantly higher than that of the patient-transfer group (56.9 percent). Left ventricular ejection fraction is a measure of the heart’s pumping ability.
According to Qi Zhang, author of the study and a cardiologist at Ruijin Hospital in Shanghai, this interventionalist-transfer strategy is feasible and effective in reducing door-to-balloon time. This alternative strategy could be an important tool in crowded Chinese cities, or in areas where ambulances and emergency staff are in short supply, the researchers concluded.
The article can be found at: .
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Source: American Heart Association.
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