Authors (including presenting author) :
Wong CY(1), Lam H(2), Mok WY(2), Tam WY(2), Chan WL (1), Lee KY (2), So FL (1), Lai LP(2), Lai JCH (1), Lee LLY(1), Yam PW(2), Lau CL(1)
Affiliation :
(1) Accident and Emergency Department, Tin Shui Wai Hospital (2) Department of Medicine and Geriatrics, Tuen Mun Hospital
Introduction :
Tin Shui Wai Hospital (TSWH) Accident and Emergency Department (AED) has implemented Hybrid Reperfusion System for ST-Elevation Myocardial Infarction (STEMI); in collaboration with Department of Medicine and Geriatrics, Tuen Mun Hospital (TMH). Within Primary Percutaneous Coronary Intervention (PCI) service hours, patients are transported for PPCI in TMH after optimization. During non-service hours, Pharmacoinvasive-PCI, comprising Fibrinolysis in TSWH AED followed by PCI in TMH 3 to 24 hours later, is performed. The American Heart Association (AHA) Guideline recommended Transport-PCI; if First-Medical-Contact-to-Device time (FMC-D) was within 120 minutes. Otherwise, Fibrinolysis should be administered at non–PCI centre if no contraindications. In a nationwide analysis in the United States, 65% of Transport-PCI cases achieved target FMC-D. Moreover, the European Society of Cardiology Guideline recommended the Diagnosis-to-Wire time in transported patients to be within 90 minutes. The average reperfusion therapy rate in Southern Europe (Greece, Spain, Italy, France) was 81.2%. From national registries in Sweden and the United Kingdom, the 30-day mortality rates of STEMI were 8.6% and 11.2% respectively.
Objectives :
(1) To review the efficiency and clinical efficacy of our reperfusion system. (2) To compare the performance of current system with international benchmarks.
Methodology :
The FMC-D time, Diagnosis-to-Wire time, en-route adverse events and 30-day mortality of all acute STEMI cases from April 2017 to December 2018 were analyzed.
Result & Outcome :
31 patients were included. 19 underwent primary PCI, with FMC-D time 75 to 245 minutes. 13 (68%) achieved the target FMC-D time. The cases not fulfilling target FMC-D time were due to equivocal diagnosis. 95% of cases achieved Diagnosis-to-Wire time within 90 minutes. There were no major adverse events en route. 10 patients belonged to Pharmacoinvasive-PCI stream. The reperfusion therapy rate was 94%. The ineligible cases were due to patient’s refusal and poor premorbid status. For PPCI and Pharmacoinvasive-PCI, the 30-day mortality was 0%. There was a case of mortality with refusal of Pharmacoinvasive-PCI after Fibrinolysis. The all-case 30-day mortality rate was 3.2%. Conclusions Our reperfusion system has remarkable outcome performance in terms of coverage and 30-day mortality. The system efficiency is well demonstrated by short Diagnosis-to-Wire time.
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