PMID- 27144285
OWN - NLM
STAT- MEDLINE
DCOM- 20170808
LR  - 20220408
IS  - 1874-1754 (Electronic)
IS  - 0167-5273 (Linking)
VI  - 216
DP  - 2016 Aug 1
TI  - Evaluating clinical reason and rationale for not delivering reperfusion therapy 
      in ST elevation myocardial infarction patients: Insights from a comprehensive 
      cohort.
PG  - 99-103
LID - S0167-5273(16)30778-1 [pii]
LID - 10.1016/j.ijcard.2016.04.075 [doi]
AB  - BACKGROUND: In ST elevation myocardial infarction (STEMI), reperfusion therapy is 
      lifesaving but is not delivered in approximately one quarter of patients. To 
      address this care gap, we reviewed all STEMI patients that did not receive 
      reperfusion to identify patient characteristics, in-hospital outcomes and the 
      clinical reason or rationale for withholding reperfusion therapy. METHODS: A 
      prospective chart review identified a consecutive cohort of STEMI patients over 
      one-year within a defined health care region with independent data abstraction. 
      Subsequently a trained nurse completed retrospective chart review and categorized 
      patients by rationale for failure to receive reperfusion. RESULTS: Of 745 STEMI 
      patients, 181 (24.3%) did not receive reperfusion. Compared to those receiving 
      reperfusion, they were older (67.5 vs. 58.0years, p=0.001) with more 
      comorbidities and higher in-hospital mortality (15.5% vs. 3.5% p=<0.0001). After 
      excluding 35 patients (unavailable data) there were 146 STEMI patients for 
      qualitative determination. Patient delay greater than 12hours from symptom onset 
      accounted for the majority of patients (56/146, 38.4%). In 19.9% (29/146), 
      conservative medical management with documented rationale occurred. Following 
      angiography, primary PCI was attempted but was unsuccessful or no culprit lesion 
      identified in 19.2% (28/146). The diagnosis of STEMI was missed or no rationale 
      for failure to deliver therapy identified in 8.2% (12/146). Death prior to 
      planned reperfusion occurred in 8 (8/146, 5.5%). CONCLUSIONS: Legitimate 
      rationale exists for the majority of STEMI patients not receiving reperfusion. 
      Ultimately, only 1.6% (12/745) of consecutive STEMI patients failed to receive 
      reperfusion without documented rationale or due to missed diagnosis.
CI  - Copyright (c) 2016. Published by Elsevier Ireland Ltd.
FAU - Welsh, Robert C
AU  - Welsh RC
AD  - University of Alberta, Canada; Mazankowski Alberta Heart Institute, Canada. 
      Electronic address: Robert.Welsh@albertahealthservices.ca.
FAU - Deckert-Sookram, Jessica
AU  - Deckert-Sookram J
AD  - Alberta Health Services, Canada.
FAU - Sookram, Sunil
AU  - Sookram S
AD  - University of Alberta, Canada.
FAU - Valaire, Shelley
AU  - Valaire S
AD  - Alberta Health Services, Canada.
FAU - Brass, Neil
AU  - Brass N
AD  - University of Alberta, Canada; Royal Alexandra Hospital, Canada.
LA  - eng
PT  - Journal Article
DEP - 20160414
PL  - Netherlands
TA  - Int J Cardiol
JT  - International journal of cardiology
JID - 8200291
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - Comorbidity
MH  - Conservative Treatment
MH  - Disease Management
MH  - Female
MH  - Guideline Adherence
MH  - Hospital Mortality
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Myocardial Reperfusion/*statistics & numerical data
MH  - Practice Guidelines as Topic
MH  - Prospective Studies
MH  - Retrospective Studies
MH  - ST Elevation Myocardial Infarction/*epidemiology/*therapy
OTO - NOTNLM
OT  - Qualitative research
OT  - Reperfusion
OT  - STEMI
EDAT- 2016/05/05 06:00
MHDA- 2017/08/09 06:00
CRDT- 2016/05/05 06:00
PHST- 2016/03/17 00:00 [received]
PHST- 2016/04/11 00:00 [accepted]
PHST- 2016/05/05 06:00 [entrez]
PHST- 2016/05/05 06:00 [pubmed]
PHST- 2017/08/09 06:00 [medline]
AID - S0167-5273(16)30778-1 [pii]
AID - 10.1016/j.ijcard.2016.04.075 [doi]
PST - ppublish
SO  - Int J Cardiol. 2016 Aug 1;216:99-103. doi: 10.1016/j.ijcard.2016.04.075. Epub 
      2016 Apr 14.