Impact of Regional Network on the Management of STEMI Patients in North Cairo

• Published in: QJM : An International Journal of Medicine Vol. 116; no. Supplement_1
• Main Authors: Saleh, Atef K, Guindy, Ramez R, Shahin, Sameh M, Okasha, Nireen K, Abdalhamid, Mohammed A, Fakhry, Hany M
• Format: Journal Article
• Language: English
• Published: 23.08.2023
• ISSN: 1460-2725; 1460-2393
• DOI: 10.1093/qjmed/hcad069.128

Abstract Background Worldwide, coronary artery disease (CAD) is the single most frequent cause of death. Over seven million people every year die from CAD. The management of patients with STElevation myocardial infarction (STEMI) is influenced by health care service organizations. Regional STEMI networks for acute myocardial infarction facilitate primary percutaneous coronary intervention (PPCI) and its efficacy in reducing mortality and improving its outcomes. Aim of the Work The aim of the present study was to examine the impact of regional STEMI network on patients' management and on hospital outcomes in north Cairo governorate, Egypt. Methods The present study is a Prospective observational multicenter study that was conducted on 352 patients with STEMI and symptom onset within 48 hours who presented to north Cairo hospitals. The patients were divided into 2 groups, group I in the first six months before establishment of a network between the north Cairo hospitals and group II in the second six months when the network between those hospitals was activated. Comparison was done between the two groups as regards patients' demographics, logistics of presentation and in hospital outcomes. Results The number of patients upon implementation of STEMI network increased from 140 to 212 (51.4%) to the same hospitals with the same facilities and in equal periods of time (6 months). It was found that the mean time of chest pain to first medical contact (FMC) between the two groups before and after establishment of STEMI network did not change, it was 4 hours in both groups (P = 0.36) while the mean door to balloon time improved from 54.3 to 44.1 minutes (P = 0.01). In our study thrombolytic therapy use declined from 36.4% before STEMI network set up to only 7.5% (P > 0.001), Ejection fraction (EF) improved from 51.3% to 55.4% (P > 0.001), mitral regurge (MR) also improved upon establishment of STEMI network from 53.6% to 78.8 with (P > 0.001), the mean CCU stay in group II was 2 days versus 3 days before implementation of STEMI network (P > 0.001), the mean door in door out from the spokes was 40 minutes. In-hospital mortality improved upon establishment of STEMI network from 6.4% to 2.8% (P = 0.10). Conclusion The establishment of the STEMI network in Egypt is feasible and can lead to improvement of patients' outcomes. Thrombolytic therapy was no longer the main reperfusion therapy and primary PCI was offered to most patients after establishment of STEMI network.