Early Primary Percutaneous Coronary Intervention in Patients with ST-segment Elevation Acute Myocardial Infarction from the Cluj Area
Keywords:ST-segment elevation acute myocardial infarction, Primary angioplasty, Time-to-treatment intervals, Total ischemia.
Aim: The seriousness of acute myocardial infarction (AMI) and the importance of its early detection and intervention are well known. Rapid reperfusion of the infarct area positively influences the immediate and long-term prognosis of patients with ST-segment elevation AMI. Material and Method: Patients with acute myocardial infarction who underwent primary percutaneous transluminal coronary angioplasty (during the first 12 hours after the onset of chest pain) in the cardiac catheterization laboratory of the Cluj-Napoca “Nicolae Stancioiu” Heart Institute between November 2008 and February 2010 were followed prospectively in order to measure time-to-treatment intervals. Results: Our sample of 321 AMI patients included mostly males (73.8% of cases, 95% CI: 68.6-78.5; p<0.001) and patients from the urban area (67.6% of cases, 95% CI: 62.1-72.6; p<0.001) aged between 50 and 79 years. Total ischemia time (from onset of precordial pain to primary angioplasty) was 338.9 minutes on average (between 100 and 720 minutes); ambulance waiting time was 22.1 minutes (3-150 minutes); transport to first hospital took 49.9 minutes (5-276 minutes) while transport to a cardiology hospital averaged 247 minutes from the onset of pain (maximum 660 minutes). The door-to-balloon time was 91.9 minutes while early intervention was possible in 27.4% (95% CI: 22.7-32.7%) of AMI cases. Conclusions: Time-to-treatment intervals allowed early reperfusion in only one third of AMI patients due to lack of access to specialised cardiology hospitals in rural areas and inconsistencies regarding the attitude towards AMI cases across counties.
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