50. Primary PCI for STEMI patients at KACC: Has patient’s access and hospital outcome improved over the last 5 years?

摘要

Primary PCI (pPCI) is Class1 indication to treat patients (pts) with S-T elevation Myocardial Infarction (STEMI). In 2010, 56% of STEMI pts presented to KACC were treated with pPCI with hospital mortality of 2.3% compared to 11.3% for those who did not qualify mainly due to late presentation. We aim to compare pts access, reason for no access to pPCI and hospital outcome 5 yrs on. Data from 2010 at KACC showed relatively low access to pPCI for STEMI pts primarily due to late presentation and initial thrombolysis. We believe that pts access to pPCI would have improved over the last 5 years due to improved public awareness and expanding evidenced-based health provision. This is a retrospective study to analyze and compare data for STEMI pts during 2010 (G1 = 223 pts) and those treated between August 2014 and August 2015 (G2 = 288 pts). We compared demographic and baseline characteristics, pts access, reason for no access and hospital mortality for the two groups. We used student-t test to compare continuous variables and Chi-square test to compare categorical onesOf the 288 pts in G2, 247 pts (85%) were males with average age of 57 yrs. 49% were diabetics, 48% hypertensive, 48% were smokers and 27% were obese. These were not different in G1. Of G2, 164 pts (57%) only had access to pPCI compared to 56% in G1 ( p = 0.536-NS). In G2, the main reasons for no pPCI was late presentation in 47% vs 53% in G1; P = 0.34-NS and 27% due to thrombolysis vs 17% in G1 ( p = 0.11NS). Hospital mortality in G2 was 4% in those treated with pPCI compared to 2.3% in G1 ( P = 0.522-NS). Mortality In pts who did not receive pPCI in G2 was 8% compared to 11.3% in G1 ( p = 0.49-NS). Females in G2 has about 3 times higher mortality. Compared to 2010, pts treated for STEMI in the last 12 months at KACC still have same, relatively low access to pPCI due mainly to persistent pattern of late presentation and prior thrombolysis which reflect apparent lack of direct access to hospitals with pPCI facilities. This seemingly relates to both lack of public awareness and health provision factors in pPCI organizations. Hospital mortality rate for pts treated with pPCI remained low during the two era while pts who did not qualify for pPCI showed a trend towards improved survival.