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• W4311360315 abstract "<h2>Abstract:</h2><h3>Background</h3> The Vancouver Coastal Health (VCH) STEMI program aimed to increase access to primary PCI (PPCI) and reduce First Medical Contact to Device Times (FMC-DT). We evaluated the long-term program impact on PPCI access and FMC-DT, and overall and reperfusion-specific in-hospital mortality. <h3>Methods</h3> We analysed all VCH STEMI patients between June 2007 and November 2019. The primary outcome was the proportion of patients receiving PPCI over 4 program implementation phases over 12 years. We also evaluated overall changes in median FMC-DT and the proportion of patients achieving guideline-mandated FMC-DT, in addition to overall and reperfusion-specific in-hospital mortality. <h3>Results</h3> 3138 of 4305 VCH STEMI patients were treated with PPCI. PPCI rates increased from 40.2% to 78.7% from 2007-2019 (p < 0.001). From Phase 1 to 4, median FMC-DT improved from 118 to 93minutes (PCI-capable hospitals, p<0.001) and 174 to 118minutes (non-PCI capable hospitals, p<0.001), with a concomitant increase in those achieving guideline-mandated FMC-DT (35.5% to 66.1%, p<0.001). Overall in-hospital mortality was 9.0% (p=0.20 across Phases), with mortality differing significantly by reperfusion strategy (4.0% fibrinolysis, 5.7% PPCI, 30.6% no reperfusion therapy, p < 0.001). Mortality significantly decreased from Phase 1 to Phase 4 at non-PCI centres (9.6% to 3.9%, p=0.022) but not at PCI-capable centres (8.7% vs 9.9%, p=0.27). <h3>Conclusions</h3> A Regional STEMI program increased the proportion of patients who received PPCI and improved reperfusion times over 12 years. While there was no statistically significant decrease in overall regional mortality, mortality was decreased for patients presenting to non-PCI centres." @default.
• W4311360315 created "2022-12-25" @default.
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• W4311360315 date "2023-03-01" @default.
• W4311360315 modified "2023-10-14" @default.
• W4311360315 title "Temporal Trends in Reperfusion Delivery and Clinical Outcomes Following Implementation of a Regional STEMI Protocol: A 12-Year Perspective" @default.
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• W4311360315 doi "https://doi.org/10.1016/j.cjco.2022.11.015" @default.
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