Acute reperfusion for ST-elevation myocardial infarction in New Zealand (2015–2017): patient and system delay (ANZACS-QI 29)
Authors: Kerr A et al.
Summary: These researchers analysed data from the All New Zealand Acute Coronary Syndrome Quality
Improvement (ANZACS-QI) registry for 3,857 patients who received acute reperfusion therapy for ST-elevation myocardial
infarction (STEMI) between 2015 and 2017. The analysis examined ‘patient’ and ‘system’ delays: ‘patient delay’ was
defined as the time from symptom onset to first medical contact (FMC); ‘system delay’ was defined as the time from FMC
until reperfusion therapy (primary percutaneous coronary intervention [PCI] or fibrinolysis). Seventy percent of the study
cohort received primary PCI; 30% received fibrinolysis. In the fibrinolysis cohort, 10.5% received pre-hospital fibrinolysis.
Most patients (77%) were transported to hospital by ambulance. In analyses adjusted for covariates, the likelihood of
travelling to hospital by ambulance was lower among people who were older, male and presented to a hospital without a
routine primary PCI service. For ambulance-transported patients, the median symptom to FMC time was 45 minutes, but
this delay was >2 hours for a quarter of patients. Delays were longer for self-transported patients (a median of 97 minutes),
with a quarter experiencing delays of >3 hours. In analyses adjusted for covariates, a delay between symptom onset and
FMC of >1 hour was more common with older age, for those of Māori or Indian ethnicity and for those who did not call an
ambulance. For ambulance-transported patients who received primary PCI, the median time was 119 minutes.
For ambulance-transported patients who received fibrinolysis, the median system delay was 86 minutes, with Māori
patients more often delayed than European/Other patients. Among patients who received pre-hospital fibrinolysis, the
median system time was 46 minutes shorter than in those who received in-hospital fibrinolysis. For the patients who
underwent rescue PCI after fibrinolysis, the median needle-to-rescue time was 237 minutes (4 hours).
Reference: N Z Med J. 2019;132(1498):41-59
Abstract
Direct transport to PCI-capable hospitals after out-of-hospital cardiac arrest in New Zealand: inequities and outcomes
Authors: Dicker B et al.
Summary: These researchers retrospectively analysed data from the St John New Zealand out-of-hospital cardiac
arrest (OHCA) registry for 1,750 adults treated for an out-of-hospital cardiac arrest of presumed cardiac aetiology between
1 October 2013 and 31 October 2018. Significantly fewer older-aged patients (>65 years) compared with those aged
45–64 years and younger (15–44 years) were transported to hospitals with PCI capability (49.9% vs 59.7% and 52.1%;
p<0.001). In a comparison of ethnicities, Pacific Peoples had the highest proportion transported to PCI-capable hospitals,
followed by Europeans and Māori (86.2% vs 55.6% and 32.9%; p<0.001). Significantly fewer patients living in rural areas
compared with those living in an urban location were transported to PCI-capable hospitals (34.7% vs 59.1%; p<0.001).
Logistic regression analysis revealed significantly higher 30-day survival in patients conveyed directly to hospitals with
PCI-capability compared with those taken to non-PCI-capable hospitals (adjusted OR 1.285; 95% CI, 1.01 to 1.63;
p=0.04).
Reference: Resuscitation. 2019;142:111-6
Abstract