Author + information
- Ajar Kochar,
- Hussein Al-Khalidi,
- Steen Hansen,
- Jay Shavadia,
- Mayme Roettig,
- Christopher Fordyce,
- James Jollis and
- Christopher Granger
Background: The only therapy shown to improve survival for STEMI-associated cardiogenic shock (CS) is early revascularization. There are limited data on achieving guideline-directed First Medical Contact (FMC)-device times for patients presenting with CS.
Methods: The AHA Mission: Lifeline STEMI Systems Accelerator project established STEMI reperfusion systems in 484 hospitals within 16 regions in the U.S. from Q3 2012 – Q1 2014. We stratified STEMI patients by CS at presentation versus no-CS at presentation and performed a Cochrane-Armitage test to evaluate trends of achieving the 90 minute guideline directed FMC-device time over 7 quarters.
Results: Among 23,785 STEMI patients, 1993 (8.4%) experienced CS at presentation. Patients with CS compared to no-CS patients were older (median age 63 vs. 60 years) and more likely to have: diabetes, prior HF and prior CABG. The in-hospital mortality of CS compared to no-CS patients was: 34% vs. 3% (p <0.001). For direct presenters via EMS, the percent of CS patients achieving the 90 minute goal of FMC-device time was: 37% vs 54% (p < 0.001). No-CS as opposed to CS patients demonstrated an improvement in FMC-device times over the course of the Accelerator intervention (Figure).
Conclusions: In STEMI Accelerator, patients with cardiogenic shock at presentation had high mortality but only 37% achieved the guideline-directed 90 minute goal of FMC-device time. These results suggest a need to develop strategies to improve FMC-device times in CS patients.
Poster Hall, Hall C
Saturday, March 18, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Novel Developments in Acute Coronary Syndromes
Abstract Category: 15. Interventional Cardiology: ACS/AMI/Hemodynamics and Pharmacology
Presentation Number: 1194-149
- 2017 American College of Cardiology Foundation