Primary PCI in ST-elevation myocardial infarction: Mode of referral and time to PCI | Revista Portuguesa de Cardiologia (English edition)

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Centro ICP-dispositivo: desde a chegada ao centro com capacidade para ICP até à utilização do primeiro dispositivo de revascularização; Dor-médico: desde o início dos sintomas até ao primeiro contacto médico; ECG-centro ICP: desde a realização do ECG diagnóstico até à chegada ao centro com capacidade de ICP; Médico-ECG: desde o primeiro contacto médico até à realização do ECG diagnóstico; Pré-Hosp: sistema de emergência pré-hospitalar; Recomendado: Tempo máximo recomendado." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Pedro Jerónimo Sousa, Rui Campante Teles, João Brito, João Abecasis, Pedro de Araújo Gonçalves, Rita Calé, Sílvio Leal, Raquel Dourado, Luís Raposo, Aniceto Silva, Manuel Almeida, Miguel Mendes" "autores" => array:12 [ 0 => array:2 [ "nombre" => "Pedro" "apellidos" => "Jerónimo Sousa" ] 1 => array:2 [ "nombre" => "Rui" "apellidos" => "Campante Teles" ] 2 => array:2 [ "nombre" => "João" "apellidos" => "Brito" ] 3 => array:2 [ "nombre" => "João" "apellidos" => "Abecasis" ] 4 => array:2 [ "nombre" => "Pedro" "apellidos" => "de Araújo Gonçalves" ] 5 => array:2 [ "nombre" => "Rita" "apellidos" => "Calé" ] 6 => array:2 [ "nombre" => "Sílvio" "apellidos" => "Leal" ] 7 => array:2 [ "nombre" => "Raquel" "apellidos" => "Dourado" ] 8 => array:2 [ "nombre" => "Luís" "apellidos" => "Raposo" ] 9 => array:2 [ "nombre" => "Aniceto" "apellidos" => "Silva" ] 10 => array:2 [ "nombre" => "Manuel" "apellidos" => "Almeida" ] 11 => array:2 [ "nombre" => "Miguel" "apellidos" => "Mendes" ] ] ] ] ] "idiomaDefecto" => "pt" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2174204912001390" "doi" => "10.1016/j.repce.2012.08.001" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204912001390?idApp=UINPBA00004E" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255112001783?idApp=UINPBA00004E" "url" => "/08702551/0000003100000010/v1_201308021325/S0870255112001783/v1_201308021325/pt/main.assets" ] ] "itemSiguiente" => array:20 [ "pii" => "S2174204912001407" "issn" => "21742049" "doi" => "10.1016/j.repce.2012.08.002" "estado" => "S300" "fechaPublicacion" => "2012-10-01" "aid" => "149" "copyright" => "Sociedade Portuguesa de Cardiologia" "documento" => "article" "crossmark" => 0 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Rev Port Cardiol. 2012;31:647-53" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 5431 "formatos" => array:3 [ "EPUB" => 130 "HTML" => 4380 "PDF" => 921 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "Original article" "titulo" => "The impact of direct access to primary angioplasty on reducing the mortality associated with anterior ST-segment elevation myocardial infarction: The experience of the Algarve region of Portugal" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "pt" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "647" "paginaFinal" => "653" ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Impacto da via verde coronária e da angioplastia primária na redução da mortalidade associada ao enfarte com elevação do segmento ST anterior. 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ECG-to-PCI center: diagnostic ECG to arrival at PCI-capable center; FMC-to-ECG: first medical contact to diagnostic ECG; Pain-to-FMC: symptom onset to first medical contact; PCI center-to-balloon: arrival at PCI-capable center to first balloon inflation; Pre-hosp: pre-hospital emergency system; Recommended: maximum recommended time." ] ] ] "textoCompleto" => "IntroductionThe treatment of choice for ST-elevation myocardial infarction (STEMI) is early reperfusion, whenever possible by primary percutaneous coronary intervention (PCI), since numerous studies have shown its superiority over thrombolysis, with better immediate and long-term outcomes.<a class="elsevierStyleCrossRef" href="#bib0005">1</a> Any delay in reperfusion can lead to a worse prognosis. In-hospital mortality following primary PCI rises from 3.0% to 4.8% with door-to-balloon times of 30min and 180min, respectively,<a class="elsevierStyleCrossRef" href="#bib0010">2</a> and 12-month mortality increases by 7.5% for each 30-min delay.<a class="elsevierStyleCrossRef" href="#bib0015">3</a>Current guidelines stress the importance of minimizing the delay between symptom onset and reperfusion. The European Society of Cardiology recommends reperfusion through primary PCI as early as possible in STEMI patients who present within 12h of symptom onset and have persistent ST-segment elevation (or presumed new complete left bundle branch block) on 12-lead electrocardiography (ECG) (class I recommendation, level of evidence A).<a class="elsevierStyleCrossRef" href="#bib0020">4</a> The delay between first medical contact (FMC) and primary PCI should be ≤2h in any STEMI patient and ≤90min in those who present within 2h of symptom onset, or with extensive anterior STEMI and low risk of bleeding (class I recommendation, level of evidence B).<a class="elsevierStyleCrossRef" href="#bib0020">4</a>Similarly, the American College of Cardiology/American Heart Association guidelines recommend that STEMI patients who come to primary PCI-capable hospitals should be treated within 90min of FMC (class I recommendation, level of evidence A), and total ischemic time should not exceed 120min.<a class="elsevierStyleCrossRef" href="#bib0025">5</a>Furthermore, given the importance of 12-lead ECG in this context, this should be performed within 10min of FMC in patients who present with chest discomfort.<a class="elsevierStyleCrossRef" href="#bib0030">6</a> Similar guidelines have been adopted by national medical societies; in Portugal the delay in transferring patients to a PCI-capable center should not exceed 30min.<a class="elsevierStyleCrossRef" href="#bib0035">7</a>The aim of this study was to analyze the treatment of STEMI patients undergoing primary PCI in a tertiary hospital, by assessing delays at different stages of treatment until primary PCI.MethodsFrom the Angioplasty and Coronary Revascularization On Santa Cruz hoSpital (ACROSS) prospective registry, which includes all consecutive patients undergoing PCI in this tertiary center since 2002, we selected 223 consecutive STEMI patients who underwent primary PCI between 2003 and 2007. The diagnosis of STEMI was established in patients with acute chest pain lasting over 30min and ST-segment elevation in at least two contiguous leads on 12-lead ECG or new complete left bundle branch block.Total times and intervals between symptom onset and primary PCI were analyzed and compared with the guidelines.The following time intervals were defined prospectively and compared with recommended times: pain-to-FMC – symptom onset to FMC (recommended time [RT]<30min); FMC to diagnostic ECG (RT<10min); ECG-to-PCI center – diagnostic ECG to arrival at PCI center (RT<30min); PCI center-to-balloon – arrival at PCI center to first balloon inflation (RT<50min); ECG-to-balloon – diagnostic ECG to first balloon inflation (RT<80min); FMC-to-balloon – FMC to first balloon inflation (RT<90min); and total ischemic time – symptom onset to first balloon inflation (RT<120min). These time intervals were defined in accordance with Portuguese and international guidelines.<a class="elsevierStyleCrossRefs" href="#bib0020">4–7</a>The population was divided into three groups based on patient origin: hospital A (6km from the center), hospital B (22km from the center), and the pre-hospital emergency system. The time intervals under study were then compared between groups.The following parameters of myocardial perfusion were also assessed: TIMI flow, TIMI frame count and ST-segment resolution following PCI. TIMI flow and TIMI frame count were calculated in accordance with published reference studies.<a class="elsevierStyleCrossRefs" href="#bib0040">8,9</a> ST-segment resolution was evaluated on the basis of the sum of all leads presenting ST elevation on the diagnostic ECG. These variables were used as surrogate markers of PCI success when the following were observed: TIMI 3 flow, TIMI frame count ≤24 and ST-segment resolution ≥70%. Differences in total ischemic time were compared in the presence and absence of these markers of successful PCI.Statistical analysisCategorical variables are presented as frequencies and percentages, and continuous variables as means±standard deviation, except for time intervals, presented as medians.Differences between continuous variables were analyzed using the Mann–Whitney or Kruskal–Wallis tests, a value of p<0.05 (95% confidence interval) being considered significant.ResultsThe mean age of the selected population of 223 patients was 60±12years, and 76% were male. The following cardiovascular risk factors were present: diabetes in 17% of patients, smoking (current or former smoker) in 56%, hypertension in 55% and dyslipidemia in 50%. At presentation, 7% were in Killip class ≥III, while 18% had a history of myocardial infarction, 19% of PCI, 4% of coronary artery bypass grafting and 5% of cerebrovascular disease, and 2% had renal failure requiring dialysis.Total time and other intervals are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> and <a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>. The median total ischemic time was 4h 30min, with only 4% undergoing PCI within 120min.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia>The intervals with the best performance were FMC-to-ECG, with a median of 8min (<10min in 59% of patients), and PCI center-to-balloon, with a median of 30min (<50min in 75%). The worst intervals were pain-to-FMC, with a median of 104min (<30min in 6%), and FMC-to-balloon, with a median of 140min (<90min in 16%).The most common patient origin was hospital A (64%), followed by hospital B (15%) and the pre-hospital emergency system (9%). The remaining 12% came from other health institutions or arrived directly at our center by their own means. Total time and other intervals for each group are shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> and <a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>. The pre-hospital group had shorter total ischemic time than patients from hospitals A and B (2h 45min vs. 4h 44min and 6h 40min, respectively, p<0.05), which was mainly due to shorter pain-to-FMC time (75 vs. 107 and 152min, p<0.05) and shorter ECG-to-PCI center time (36 vs. 106 and 99min, p<0.05).<elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia>Of the total population, 203 patients were not referred directly to our center by the pre-hospital emergency system, and 63% of these arrived at the hospital by their own means, while the other 37% were transported by ambulance (with pre-hospital medical assessment in at least 15% of these) (<a class="elsevierStyleCrossRef" href="#fig0015">Figure 3</a>).<elsevierMultimedia ident="fig0015"></elsevierMultimedia>With regard to PCI outcomes, TIMI 3 flow was obtained in 83% of patients, TIMI frame count ≤24 in 59%, and ST-segment resolution ≥70% in 45%. Successful PCI based on these surrogate markers was associated with shorter total ischemic time: median total ischemic time in patients with TIMI 3 flow was 4h 17min (vs. 7h 03min in those with TIMI 2 flow, p=0.02); in those with TIMI frame count ≤24 it was 4h 11min (vs. 5h 00min in those with TIMI frame count >24, p=0.03); and in those with ST-segment resolution ≥70% it was 3h 59min (vs. 5h 12min in those with ST resolution <70%, p=0.02) (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>).<elsevierMultimedia ident="tbl0015"></elsevierMultimedia>DiscussionThe link between the duration of myocardial ischemia and prognosis in the context of STEMI has been clearly established and achieving myocardial reperfusion as rapidly as possible is now a priority. Indeed, in recent years, the focus of STEMI treatment has been to reorganize health services so as to provide treatment with the minimum delay.A study by Le May et al.<a class="elsevierStyleCrossRef" href="#bib0050">10</a> analyzed time intervals defined in a similar way to ours: ECG-to-PCI center (median 38min), PCI center-to-balloon (median 57min), ECG-to-balloon (median 104min) and total ischemic time (median 201min). The times observed in that study were shorter than those found in our population, with the exception PCI center-to-balloon time, probably the result of greater delay in patients arriving at our center, thus giving more time to organize the logistics and PCI team. The study also compared differences in times between patients referred directly via a pre-hospital system and those from other hospitals. As in our study, all the time intervals were significantly shorter when patients were referred directly via a pre-hospital system. Median delays for this subgroup were similar in both studies, but Le May et al. reported a significantly higher proportion of patients referred from a pre-hospital environment (39% vs. 9% in our study), which could explain the greater delays observed in our population.Another study analyzing STEMI patients referred for primary PCI by pre-hospital teams found that in 66.7% of cases the time between FMC and PCI was <90min,<a class="elsevierStyleCrossRef" href="#bib0055">11</a> which is similar to the FMC-to-balloon time observed in our pre-hospital group.In a multicenter study combining information from 30 countries,<a class="elsevierStyleCrossRef" href="#bib0060">12</a> the time reported from symptom onset to FMC (defined as performance of diagnostic ECG) varied between 60 and 210min, and from FMC to balloon between 60 and 177min. The delays found in our population are around the middle of the range in that study.With regard to Portugal, a study by Trigo et al.<a class="elsevierStyleCrossRef" href="#bib0065">13</a> reported median pre-hospital delays between 3h 31min and 4h 05min, slightly longer than in our study. On the other hand, median in-hospital delays ranged between 1h 26min and 2h 15min, slightly shorter than found in our population. The differences may be related to organizational differences between the two centers: our hospital's referral area is smaller (resulting in shorter pre-hospital delays) but it has no on-site emergency department and thus most referrals come from other hospitals (resulting in longer in-hospital delays). Another study, by Ribeiro et al.,<a class="elsevierStyleCrossRef" href="#bib0070">14</a> analyzed pre-hospital delays in this context, reporting a median of 2.16h, similar to our population. Lastly, Ramos et al.<a class="elsevierStyleCrossRef" href="#bib0075">15</a> observed a median total ischemic time of 7.64h (12.1h in patients presenting with cardiogenic shock), slightly longer than in our patients.We found shorter delays in patients referred for PCI via the pre-hospital emergency system. However, a significant proportion of the remaining patients had been assessed by medical personnel before being transported to a non-PCI capable hospital. These patients had either not undergone pre-hospital ECG or if they had, a diagnosis of STEMI had not been made.Analysis of surrogate markers of successful myocardial reperfusion following PCI revealed an association between shorter total ischemic time and better final TIMI flow, lower final TIMI frame count and greater ST-segment resolution. This suggests that shorter total ischemic time results in a higher probability of successful PCI. Similar findings have been observed in other studies that report an association between shorter ischemic time and better primary PCI outcome as assessed by corrected TIMI frame count.<a class="elsevierStyleCrossRef" href="#bib0080">16</a> We found no mention in the literature of an association between shorter ischemic time and better TIMI flow or greater ST-segment resolution after primary PCI for STEMI. However, these parameters have been thoroughly studied as markers of successful PCI.<a class="elsevierStyleCrossRefs" href="#bib0085">17,18</a> The association found in our study between better PCI outcome based on these markers and shorter ischemic time highlights the importance of prompt reperfusion in STEMI.ConclusionThis study shows that, despite the availability of a 24-h pre-hospital emergency system and the fact that patients with myocardial infarction referred via this system present significantly shorter total ischemic times, only a small percentage of patients actually use it, confirming that the attitude of patients with STEMI plays a crucial role in outcomes and compliance with guidelines. The longest delays were in pain-to-FMC and FMC-to-balloon times, the latter being attributable to the internal organization of hospitals.In this population, only a minority of STEMI patients were revascularized within the recommended time limits. The responsibility for the delays observed would appear to be multifactorial, related not only to the failure of patients to seek immediate medical assistance when experiencing chest pain but also to organizational aspects of the different health systems involved.Conflicts of interestThe authors have no conflicts of interest to declare." "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:2 [ "identificador" => "xres176061" "titulo" => array:5 [ 0 => "Abstract" 1 => "Introduction" 2 => "Methods" 3 => "Results" 4 => "Conclusions" ] ] 1 => array:2 [ "identificador" => "xpalclavsec164435" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres176062" "titulo" => array:5 [ 0 => "Resumo" 1 => "Introdução" 2 => "Métodos" 3 => "Resultados" 4 => "Conclusão" ] ] 3 => array:2 [ "identificador" => "xpalclavsec164436" "titulo" => "Palavras-chave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Statistical analysis" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Results" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Discussion" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Conclusion" ] 10 => array:2 [ "identificador" => "sec0035" "titulo" => "Conflicts of interest" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2011-06-15" "fechaAceptado" => "2012-04-23" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec164435" "palabras" => array:2 [ 0 => "Primary PCI" 1 => "ST-segment elevation myocardial infarction" ] ] ] "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec164436" "palabras" => array:2 [ 0 => "Angioplastia primária" 1 => "Enfarte de miocárdio com supra-desnivelamento do segmento ST" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "IntroductionAccording to the current guidelines for treatment of ST-elevation myocardial infarction (STEMI), percutaneous coronary intervention (PCI) should be performed within 90min of first medical contact and total ischemic time should not exceed 120min. The aim of this study was to analyze compliance with STEMI guidelines in a tertiary PCI center. MethodsThis was a prospective single-center registry of 223 consecutive STEMI patients referred for primary PCI between 2003 and 2007. ResultsIn this population (mean age 60±12years, 76% male), median total ischemic time was 4h 30min (<120min in 4% of patients). The interval with the best performance was first medical contact to first ECG (median 8min, <10min in 59% of patients). The worst intervals were symptom onset to first medical contact (median 104min, <30min in 6%) and first ECG to PCI (median 140min, <90min in 16%).Shorter total ischemic time was associated with better post-PCI TIMI flow, TIMI frame count and ST-segment resolution (p<0.03). The three most common patient origins were two nearby hospitals (A and B) and the pre-hospital emergency system. The pre-hospital group had shorter total ischemic time than patients from hospitals A or B (2h 45min vs. 4h 44min and 6h 40min, respectively, p<0.05), with shorter door-to-balloon time (89min vs. 147min and 146min, respectively, p<0.05). ConclusionsIn this population, only a small proportion of patients with acute myocardial infarction underwent primary PCI within the recommended time. Patients referred through the pre-hospital emergency system, although a minority, had the best results in terms of early treatment. Compliance with the guidelines translates into better myocardial perfusion achieved through primary PCI." ] "pt" => array:2 [ "titulo" => "Resumo" "resumen" => "IntroduçãoSegundo as recomendações atuais para o tratamento do enfarte agudo do miocárdio com supradesnivelamento do segmento ST a intervenção coronária percutânea deve ser efetuada dentro de 90min após o primeiro contacto médico e o tempo total de isquémia não deve exceder os 120min.O objetivo deste trabalho foi analisar a adequação da implementação destas recomendações para o enfarte do miocárdio com supradesnivelamento do segmento ST num centro terciário de intervenção coronária percutânea. MétodosRegisto prospetivo de centro único de 223 doentes consecutivos referenciados para intervenção coronária percutânea primária entre 2003 e 2007. ResultadosNesta população (idade média 60±12 anos, 76% de sexo masculino), a mediana do tempo total de isquémia foi 4h 30min (<120min em 4% dos doentes). O intervalo de tempo com menor atraso foi desde o primeiro contacto médico até à realização do ECG (mediana 8min, <10min em 59% dos doentes). Os intervalos com maior atraso foram: do início dos sintomas ao primeiro contacto médico (mediana 104min, <30min em 6% dos doentes) e do primeiro ECG à realização da intervenção coronária (mediana 140min, <90min em 16% dos doentes). O menor tempo total de isquémia associou-se a melhor fluxo TIMI final, melhor TIMI frame count final e maior resolução do segmento ST após angioplastia (p<0,03).As 3 origens mais frequentes dos doentes foram: 2 hospitais de localidades próximas e o sistema de emergência médica pré-hospitalar. No grupo pré-hospitalar verificou-se menor tempo total de isquémia que nos hospitais A ou B (2h 45min versus 4h 44min e 6h 40min, p<0,05), com menor tempo desde o primeiro contacto médico até à angioplastia (89min versus 147 e 146min, p<0,05). ConclusãoNesta população, apenas uma reduzida percentagem de doentes com enfarte agudo do miocárdio obteve tratamento adequado por angioplastia primária dentro dos tempos recomendados. Os doentes referenciados pelo sistema de emergência pré-hospitalar, embora em reduzida percentagem do total, foram os que obtiveram os melhores resultados na precocidade do tratamento. O cumprimento das recomendações traduz-se em melhores resultados na perfusão miocárdica obtida pela angioplastia primária." ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Sousa, P. ICP primária no enfarte de miocárdio com supradesnivelamento do segmento ST: tempo para intervenção e modos de referenciação. Rev Port Cardiol. 2012. doi:10.1016/j.repc.2012.07.006" ] ] "multimedia" => array:6 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1493 "Ancho" => 1312 "Tamanyo" => 92267 ] ] "descripcion" => array:1 [ "en" => "Median total time and other time intervals in the overall population compared with maximum recommended times. ECG-to-PCI center: diagnostic ECG to arrival at PCI-capable center; FMC-to-ECG: first medical contact to diagnostic ECG; Pain-to-FMC: symptom onset to first medical contact; PCI center-to-balloon: arrival at PCI-capable center to first balloon inflation; Recommended: maximum recommended time." ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1111 "Ancho" => 1618 "Tamanyo" => 95934 ] ] "descripcion" => array:1 [ "en" => "Median total and other time intervals compared with maximum recommended times according to patient origin. ECG-to-PCI center: diagnostic ECG to arrival at PCI-capable center; FMC-to-ECG: first medical contact to diagnostic ECG; Pain-to-FMC: symptom onset to first medical contact; PCI center-to-balloon: arrival at PCI-capable center to first balloon inflation; Pre-hosp: pre-hospital emergency system; Recommended: maximum recommended time." ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 618 "Ancho" => 1437 "Tamanyo" => 52517 ] ] "descripcion" => array:1 [ "en" => "Means of patient transport to first non-PCI capable hospital. Ambulance: ambulance without doctor (pre-hospital emergency system or private transport)." ] ] 3 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "ECG-to-balloon: diagnostic ECG to use of first balloon inflation; ECG-to-PCI center: diagnostic ECG to arrival at PCI-capable center; FMC-to-balloon: first medical contact to use of first balloon inflation; FMC-to-ECG: first medical contact to diagnostic ECG;" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Max RT \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Observed \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">< Max RT (%) \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pain-to-FMC \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0h 30min \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1h 45min \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6.0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">FMC-to-ECG \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0h 10min \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0h 08min \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">58.5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ECG-to-PCI center \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0h 30min \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1h 34min \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7.0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">PCI center-to-balloon \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0h 50min \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0h 30min \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">75.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ECG-to-balloon \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1h 20min \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2h 03min \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">FMC-to-balloon \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1h 30min \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2h 20min \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16.0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Total ischemic time \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2h 00min \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4h 30min \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.7 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab268606.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Median times in the overall population compared to maximum recommended times." ] ] 4 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "ECG-to-balloon: diagnostic ECG to first balloon inflation; ECG-to-PCI center: diagnostic ECG to arrival at PCI-capable center; FMC-to-balloon: first medical contact to first balloon inflation; FMC-to-ECG: first medical contact to diagnostic ECG;" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Max RT \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Pre-hospital</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Hospital A</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Hospital B</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Observed \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">< Max RT (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Observed \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">< Max RT (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Observed \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">< Max RT (%) \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pain-to-FMC \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0h 30min \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1h 15min \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1h 47min \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2h 32min \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">FMC-to-ECG \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0h 10min \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0h 07min \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">71.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0h 13min \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">48.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0h 06min \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">64.7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ECG-to-PCI center \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0h 30min \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0h 36min \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">33.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1h 46min \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1h 39min \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">PCI center-to-balloon \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0h 50min \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0h 44min \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">62.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0h 27min \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">88.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0h 24min \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">84.6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ECG-to-balloon \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1h 20min \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1h 22min \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">50.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2h 20min \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2h 22min \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">FMC-to-balloon \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1h 30min \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1h 29min \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">64.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2h 27min \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2h 26min \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Total ischemic time \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2h 00min \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2h 45min \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4h 44min \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6h 40min \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.0 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab268605.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Median times compared to maximum recommended times according to patient origin." ] ] 5 => array:7 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "TIMI: TIMI flow after PCI; TIMI frame count: corrected TIMI frame count after PCI." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Total ischemic time \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">TIMI 2 vs. 3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 h 03min vs. 4h 17min \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.02 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">TIMI frame count >24 vs. ≤24 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 h 00min vs. 4h 11min \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.03 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ST resolution <70% vs. ≥70% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 h 12min vs. 3h 59min \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.002 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab268607.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Median total ischemic times according to surrogate markers of successful PCI." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:18 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Primary angioplasty versus intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review of 23 randomised trials" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "E.C. Keeley" 1 => "J.A. Boura" 2 => "C.L. Grines" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0140-6736(03)12113-7" "Revista" => array:6 [ "tituloSerie" => "Lancet" "fecha" => "2003" "volumen" => "361" "paginaInicial" => "13" "paginaFinal" => "20" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12517460" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Association of door-to-balloon time and mortality in patients admitted to hospital with ST elevation myocardial infarction: national cohort study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "S.S. Rathore" 1 => "J.P. Curtis" 2 => "J. Chen" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "BMJ" "fecha" => "2009" "volumen" => "338" "paginaInicial" => "b1807" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19454739" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Time delay to treatment and mortality in primary angioplasty for acute myocardial infarction: every minute of delay counts" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "G. De Luca" 1 => "H. Suryapranata" 2 => "J.P. 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Zorkun" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s11239-008-0220-3" "Revista" => array:6 [ "tituloSerie" => "J Thromb Thrombolysis" "fecha" => "2009" "volumen" => "27" "paginaInicial" => "316" "paginaFinal" => "328" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18425623" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A citywide protocol for primary PCI in ST-segment elevation myocardial infarction" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "M.R. Le May" 1 => "D.Y. So" 2 => "R. Dionne" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMoa073102" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2008" "volumen" => "358" "paginaInicial" => "231" "paginaFinal" => "240" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18199862" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0055" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Association between prehospital time intervals and ST-elevation myocardial infarction system performance" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "J.R. Studnek" 1 => "L. Garvey" 2 => "T. 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Mimoso" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Rev Port Cardiol" "fecha" => "2008" "volumen" => "27" "paginaInicial" => "1251" "paginaFinal" => "1259" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19178027" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0070" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Preditores de demora pré-hospitalar em doentes com enfarte agudo do miocárdio com elevação do segmento ST" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "S. Ribeiro" 1 => "A. Gaspar" 2 => "S. Rocha" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Rev Port Cardiol" "fecha" => "2010" "volumen" => "29" "paginaInicial" => "1521" "paginaFinal" => "1532" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21265494" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0075" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Resultados da angioplastia primária num centro de referência. Evolução intra-hospitalar" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "R. Ramos" 1 => "L. Patrício" 2 => "L. Bernardes" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Rev Port Cardiol" "fecha" => "2009" "volumen" => "28" "paginaInicial" => "1063" "paginaFinal" => "1084" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20058775" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0080" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Relation between door-to-balloon time and microvascular perfusion as evaluated by myocardial blush grade, corrected TIMI frame count, and ST-segment resolution in treatment of acute myocardial infarction" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "C.H. Lee" 1 => "B.C. Tai" 2 => "C. Lau" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1540-8183.2009.00493.x" "Revista" => array:6 [ "tituloSerie" => "J Interv Cardiol" "fecha" => "2009" "volumen" => "22" "paginaInicial" => "437" "paginaFinal" => "443" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19674244" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0085" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "TIMI flow and surrogate end points: what you see is not always what you get" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "W.A. Tan" 1 => "D.J. 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Primary PCI in ST-elevation myocardial infarction: Mode of referral and time to PCI

ICP primária no enfarte de miocárdio com supradesnivelamento do segmento ST: tempo para intervenção e modos de referenciação

Pedro Jerónimo Sousa

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p965675551@gmail.com

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, Rui Campante Teles, João Brito, João Abecasis, Pedro de Araújo Gonçalves, Rita Calé, Sílvio Leal, Raquel Dourado, Luís Raposo, Aniceto Silva, Manuel Almeida, Miguel Mendes

Serviço de Cardiologia, Hospital de Santa Cruz, Carnaxide, Portugal

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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The treatment of choice for ST-elevation myocardial infarction &#40;STEMI&#41; is early reperfusion&#44; whenever possible by primary percutaneous coronary intervention &#40;PCI&#41;&#44; since numerous studies have shown its superiority over thrombolysis&#44; with better immediate and long-term outcomes&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Any delay in reperfusion can lead to a worse prognosis&#46; In-hospital mortality following primary PCI rises from 3&#46;0&#37; to 4&#46;8&#37; with door-to-balloon times of 30<span class="elsevierStyleHsp" style=""></span>min and 180<span class="elsevierStyleHsp" style=""></span>min&#44; respectively&#44;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> and 12-month mortality increases by 7&#46;5&#37; for each 30-min delay&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Current guidelines stress the importance of minimizing the delay between symptom onset and reperfusion&#46; The European Society of Cardiology recommends reperfusion through primary PCI as early as possible in STEMI patients who present within 12<span class="elsevierStyleHsp" style=""></span>h of symptom onset and have persistent ST-segment elevation &#40;or presumed new complete left bundle branch block&#41; on 12-lead electrocardiography &#40;ECG&#41; &#40;class I recommendation&#44; level of evidence A&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> The delay between first medical contact &#40;FMC&#41; and primary PCI should be &#8804;2<span class="elsevierStyleHsp" style=""></span>h in any STEMI patient and &#8804;90<span class="elsevierStyleHsp" style=""></span>min in those who present within 2<span class="elsevierStyleHsp" style=""></span>h of symptom onset&#44; or with extensive anterior STEMI and low risk of bleeding &#40;class I recommendation&#44; level of evidence B&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Similarly&#44; the American College of Cardiology&#47;American Heart Association guidelines recommend that STEMI patients who come to primary PCI-capable hospitals should be treated within 90<span class="elsevierStyleHsp" style=""></span>min of FMC &#40;class I recommendation&#44; level of evidence A&#41;&#44; and total ischemic time should not exceed 120<span class="elsevierStyleHsp" style=""></span>min&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Furthermore&#44; given the importance of 12-lead ECG in this context&#44; this should be performed within 10<span class="elsevierStyleHsp" style=""></span>min of FMC in patients who present with chest discomfort&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Similar guidelines have been adopted by national medical societies&#59; in Portugal the delay in transferring patients to a PCI-capable center should not exceed 30<span class="elsevierStyleHsp" style=""></span>min&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The aim of this study was to analyze the treatment of STEMI patients undergoing primary PCI in a tertiary hospital&#44; by assessing delays at different stages of treatment until primary PCI&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Methods</span><p id="par0030" class="elsevierStylePara elsevierViewall">From the Angioplasty and Coronary Revascularization On Santa Cruz hoSpital &#40;ACROSS&#41; prospective registry&#44; which includes all consecutive patients undergoing PCI in this tertiary center since 2002&#44; we selected 223 consecutive STEMI patients who underwent primary PCI between 2003 and 2007&#46; The diagnosis of STEMI was established in patients with acute chest pain lasting over 30<span class="elsevierStyleHsp" style=""></span>min and ST-segment elevation in at least two contiguous leads on 12-lead ECG or new complete left bundle branch block&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Total times and intervals between symptom onset and primary PCI were analyzed and compared with the guidelines&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The following time intervals were defined prospectively and compared with recommended times&#58; pain-to-FMC &#8211; symptom onset to FMC &#40;recommended time &#91;RT&#93;<span class="elsevierStyleHsp" style=""></span>&#60;30<span class="elsevierStyleHsp" style=""></span>min&#41;&#59; FMC to diagnostic ECG &#40;RT<span class="elsevierStyleHsp" style=""></span>&#60;10<span class="elsevierStyleHsp" style=""></span>min&#41;&#59; ECG-to-PCI center &#8211; diagnostic ECG to arrival at PCI center &#40;RT<span class="elsevierStyleHsp" style=""></span>&#60;30<span class="elsevierStyleHsp" style=""></span>min&#41;&#59; PCI center-to-balloon &#8211; arrival at PCI center to first balloon inflation &#40;RT<span class="elsevierStyleHsp" style=""></span>&#60;50<span class="elsevierStyleHsp" style=""></span>min&#41;&#59; ECG-to-balloon &#8211; diagnostic ECG to first balloon inflation &#40;RT<span class="elsevierStyleHsp" style=""></span>&#60;80<span class="elsevierStyleHsp" style=""></span>min&#41;&#59; FMC-to-balloon &#8211; FMC to first balloon inflation &#40;RT<span class="elsevierStyleHsp" style=""></span>&#60;90<span class="elsevierStyleHsp" style=""></span>min&#41;&#59; and total ischemic time &#8211; symptom onset to first balloon inflation &#40;RT<span class="elsevierStyleHsp" style=""></span>&#60;120<span class="elsevierStyleHsp" style=""></span>min&#41;&#46; These time intervals were defined in accordance with Portuguese and international guidelines&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#8211;7</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">The population was divided into three groups based on patient origin&#58; hospital A &#40;6<span class="elsevierStyleHsp" style=""></span>km from the center&#41;&#44; hospital B &#40;22<span class="elsevierStyleHsp" style=""></span>km from the center&#41;&#44; and the pre-hospital emergency system&#46; The time intervals under study were then compared between groups&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">The following parameters of myocardial perfusion were also assessed&#58; TIMI flow&#44; TIMI frame count and ST-segment resolution following PCI&#46; TIMI flow and TIMI frame count were calculated in accordance with published reference studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;9</span></a> ST-segment resolution was evaluated on the basis of the sum of all leads presenting ST elevation on the diagnostic ECG&#46; These variables were used as surrogate markers of PCI success when the following were observed&#58; TIMI 3 flow&#44; TIMI frame count &#8804;24 and ST-segment resolution &#8805;70&#37;&#46; Differences in total ischemic time were compared in the presence and absence of these markers of successful PCI&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Statistical analysis</span><p id="par0055" class="elsevierStylePara elsevierViewall">Categorical variables are presented as frequencies and percentages&#44; and continuous variables as means&#177;standard deviation&#44; except for time intervals&#44; presented as medians&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Differences between continuous variables were analyzed using the Mann&#8211;Whitney or Kruskal&#8211;Wallis tests&#44; a value of p&#60;0&#46;05 &#40;95&#37; confidence interval&#41; being considered significant&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Results</span><p id="par0065" class="elsevierStylePara elsevierViewall">The mean age of the selected population of 223 patients was 60&#177;12<span class="elsevierStyleHsp" style=""></span>years&#44; and 76&#37; were male&#46; The following cardiovascular risk factors were present&#58; diabetes in 17&#37; of patients&#44; smoking &#40;current or former smoker&#41; in 56&#37;&#44; hypertension in 55&#37; and dyslipidemia in 50&#37;&#46; At presentation&#44; 7&#37; were in Killip class &#8805;III&#44; while 18&#37; had a history of myocardial infarction&#44; 19&#37; of PCI&#44; 4&#37; of coronary artery bypass grafting and 5&#37; of cerebrovascular disease&#44; and 2&#37; had renal failure requiring dialysis&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Total time and other intervals are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> and <a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>&#46; The median total ischemic time was 4<span class="elsevierStyleHsp" style=""></span>h 30<span class="elsevierStyleHsp" style=""></span>min&#44; with only 4&#37; undergoing PCI within 120<span class="elsevierStyleHsp" style=""></span>min&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">The intervals with the best performance were FMC-to-ECG&#44; with a median of 8<span class="elsevierStyleHsp" style=""></span>min &#40;&#60;10<span class="elsevierStyleHsp" style=""></span>min in 59&#37; of patients&#41;&#44; and PCI center-to-balloon&#44; with a median of 30<span class="elsevierStyleHsp" style=""></span>min &#40;&#60;50<span class="elsevierStyleHsp" style=""></span>min in 75&#37;&#41;&#46; The worst intervals were pain-to-FMC&#44; with a median of 104<span class="elsevierStyleHsp" style=""></span>min &#40;&#60;30<span class="elsevierStyleHsp" style=""></span>min in 6&#37;&#41;&#44; 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respectively&#44; p&#60;0&#46;05&#41;&#44; which was mainly due to shorter pain-to-FMC time &#40;75 vs&#46; 107 and 152<span class="elsevierStyleHsp" style=""></span>min&#44; p&#60;0&#46;05&#41; and shorter ECG-to-PCI center time &#40;36 vs&#46; 106 and 99<span class="elsevierStyleHsp" style=""></span>min&#44; p&#60;0&#46;05&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">Of the total population&#44; 203 patients were not referred directly to our center by the pre-hospital emergency system&#44; and 63&#37; of these arrived at the hospital by their own means&#44; while the other 37&#37; were transported by ambulance &#40;with pre-hospital medical assessment in at least 15&#37; of these&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Figure 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">With regard to PCI outcomes&#44; TIMI 3 flow was obtained in 83&#37; of patients&#44; TIMI frame count &#8804;24 in 59&#37;&#44; and ST-segment resolution &#8805;70&#37; in 45&#37;&#46; Successful PCI based on these surrogate markers was associated with shorter total ischemic time&#58; median total ischemic time in patients with TIMI 3 flow was 4<span class="elsevierStyleHsp" style=""></span>h 17<span class="elsevierStyleHsp" style=""></span>min &#40;vs&#46; 7<span class="elsevierStyleHsp" style=""></span>h 03<span class="elsevierStyleHsp" style=""></span>min in those with TIMI 2 flow&#44; p&#61;0&#46;02&#41;&#59; in those with TIMI frame count &#8804;24 it was 4<span class="elsevierStyleHsp" style=""></span>h 11<span class="elsevierStyleHsp" style=""></span>min &#40;vs&#46; 5<span class="elsevierStyleHsp" style=""></span>h 00<span class="elsevierStyleHsp" style=""></span>min in those with TIMI frame count &#62;24&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;03&#41;&#59; and in those with ST-segment resolution &#8805;70&#37; it was 3<span class="elsevierStyleHsp" style=""></span>h 59<span class="elsevierStyleHsp" style=""></span>min &#40;vs&#46; 5<span class="elsevierStyleHsp" style=""></span>h 12<span class="elsevierStyleHsp" style=""></span>min in those with ST resolution &#60;70&#37;&#44; p&#61;0&#46;02&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discussion</span><p id="par0095" class="elsevierStylePara elsevierViewall">The link between the duration of myocardial ischemia and prognosis in the context of STEMI has been clearly established and achieving myocardial reperfusion as rapidly as possible is now a priority&#46; Indeed&#44; in recent years&#44; the focus of STEMI treatment has been to reorganize health services so as to provide treatment with the minimum delay&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">A study by Le May et al&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> analyzed time intervals defined in a similar way to ours&#58; ECG-to-PCI center &#40;median 38<span class="elsevierStyleHsp" style=""></span>min&#41;&#44; PCI center-to-balloon &#40;median 57<span class="elsevierStyleHsp" style=""></span>min&#41;&#44; ECG-to-balloon &#40;median 104<span class="elsevierStyleHsp" style=""></span>min&#41; and total ischemic time &#40;median 201<span class="elsevierStyleHsp" style=""></span>min&#41;&#46; The times observed in that study were shorter than those found in our population&#44; with the exception PCI center-to-balloon time&#44; probably the result of greater delay in patients arriving at our center&#44; thus giving more time to organize the logistics and PCI team&#46; The study also compared differences in times between patients referred directly via a pre-hospital system and those from other hospitals&#46; As in our study&#44; all the time intervals were significantly shorter when patients were referred directly via a pre-hospital system&#46; Median delays for this subgroup were similar in both studies&#44; but Le May et al&#46; reported a significantly higher proportion of patients referred from a pre-hospital environment &#40;39&#37; vs&#46; 9&#37; in our study&#41;&#44; which could explain the greater delays observed in our population&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Another study analyzing STEMI patients referred for primary PCI by pre-hospital teams found that in 66&#46;7&#37; of cases the time between FMC and PCI was &#60;90<span class="elsevierStyleHsp" style=""></span>min&#44;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> which is similar to the FMC-to-balloon time observed in our pre-hospital group&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">In a multicenter study combining information from 30 countries&#44;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> the time reported from symptom onset to FMC &#40;defined as performance of diagnostic ECG&#41; varied between 60 and 210<span class="elsevierStyleHsp" style=""></span>min&#44; and from FMC to balloon between 60 and 177<span class="elsevierStyleHsp" style=""></span>min&#46; The delays found in our population are around the middle of the range in that study&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">With regard to Portugal&#44; a study by Trigo et al&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> reported median pre-hospital delays between 3<span class="elsevierStyleHsp" style=""></span>h 31<span class="elsevierStyleHsp" style=""></span>min and 4<span class="elsevierStyleHsp" style=""></span>h 05<span class="elsevierStyleHsp" style=""></span>min&#44; slightly longer than in our study&#46; On the other hand&#44; median in-hospital delays ranged between 1<span class="elsevierStyleHsp" style=""></span>h 26<span class="elsevierStyleHsp" style=""></span>min and 2<span class="elsevierStyleHsp" style=""></span>h 15<span class="elsevierStyleHsp" style=""></span>min&#44; slightly shorter than found in our population&#46; The differences may be related to organizational differences between the two centers&#58; our hospital&#39;s referral area is smaller &#40;resulting in shorter pre-hospital delays&#41; but it has no on-site emergency department and thus most referrals come from other hospitals &#40;resulting in longer in-hospital delays&#41;&#46; Another study&#44; by Ribeiro et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> analyzed pre-hospital delays in this context&#44; reporting a median of 2&#46;16<span class="elsevierStyleHsp" style=""></span>h&#44; similar to our population&#46; Lastly&#44; Ramos et al&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> observed a median total ischemic time of 7&#46;64<span class="elsevierStyleHsp" style=""></span>h &#40;12&#46;1<span class="elsevierStyleHsp" style=""></span>h in patients presenting with cardiogenic shock&#41;&#44; slightly longer than in our patients&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">We found shorter delays in patients referred for PCI via the pre-hospital emergency system&#46; However&#44; a significant proportion of the remaining patients had been assessed by medical personnel before being transported to a non-PCI capable hospital&#46; These patients had either not undergone pre-hospital ECG or if they had&#44; a diagnosis of STEMI had not been made&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Analysis of surrogate markers of successful myocardial reperfusion following PCI revealed an association between shorter total ischemic time and better final TIMI flow&#44; lower final TIMI frame count and greater ST-segment resolution&#46; This suggests that shorter total ischemic time results in a higher probability of successful PCI&#46; Similar findings have been observed in other studies that report an association between shorter ischemic time and better primary PCI outcome as assessed by corrected TIMI frame count&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> We found no mention in the literature of an association between shorter ischemic time and better TIMI flow or greater ST-segment resolution after primary PCI for STEMI&#46; However&#44; these parameters have been thoroughly studied as markers of successful PCI&#46;<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">17&#44;18</span></a> The association found in our study between better PCI outcome based on these markers and shorter ischemic time highlights the importance of prompt reperfusion in STEMI&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conclusion</span><p id="par0130" class="elsevierStylePara elsevierViewall">This study shows that&#44; despite the availability of a 24-h pre-hospital emergency system and the fact that patients with myocardial infarction referred via this system present significantly shorter total ischemic times&#44; only a small percentage of patients actually use it&#44; confirming that the attitude of patients with STEMI plays a crucial role in outcomes and compliance with guidelines&#46; The longest delays were in pain-to-FMC and FMC-to-balloon times&#44; the latter being attributable to the internal organization of hospitals&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">In this population&#44; only a minority of STEMI patients were revascularized within the recommended time limits&#46; The responsibility for the delays observed would appear to be multifactorial&#44; related not only to the failure of patients to seek immediate medical assistance when experiencing chest pain but also to organizational aspects of the different health systems involved&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflicts of interest</span><p id="par0140" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">According to the current guidelines for treatment of ST-elevation myocardial infarction &#40;STEMI&#41;&#44; percutaneous coronary intervention &#40;PCI&#41; should be performed within 90<span class="elsevierStyleHsp" style=""></span>min of first medical contact and total ischemic time should not exceed 120<span class="elsevierStyleHsp" style=""></span>min&#46; The aim of this study was to analyze compliance with STEMI guidelines in a tertiary PCI center&#46;</p> <span class="elsevierStyleSectionTitle">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">This was a prospective single-center registry of 223 consecutive STEMI patients referred for primary PCI between 2003 and 2007&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">In this population &#40;mean age 60&#177;12<span class="elsevierStyleHsp" style=""></span>years&#44; 76&#37; male&#41;&#44; median total ischemic time was 4<span class="elsevierStyleHsp" style=""></span>h 30<span class="elsevierStyleHsp" style=""></span>min &#40;&#60;120<span class="elsevierStyleHsp" style=""></span>min in 4&#37; of patients&#41;&#46; The interval with the best performance was first medical contact to first ECG &#40;median 8<span class="elsevierStyleHsp" style=""></span>min&#44; &#60;10<span class="elsevierStyleHsp" style=""></span>min in 59&#37; of patients&#41;&#46; The worst intervals were symptom onset to first medical contact &#40;median 104<span class="elsevierStyleHsp" style=""></span>min&#44; &#60;30<span class="elsevierStyleHsp" style=""></span>min in 6&#37;&#41; and first ECG to PCI &#40;median 140<span class="elsevierStyleHsp" style=""></span>min&#44; &#60;90<span class="elsevierStyleHsp" style=""></span>min in 16&#37;&#41;&#46;</p><p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">Shorter total ischemic time was associated with better post-PCI TIMI flow&#44; TIMI frame count and ST-segment resolution &#40;p&#60;0&#46;03&#41;&#46; The three most common patient origins were two nearby hospitals &#40;A and B&#41; and the pre-hospital emergency system&#46; The pre-hospital group had shorter total ischemic time than patients from hospitals A or B &#40;2<span class="elsevierStyleHsp" style=""></span>h 45<span class="elsevierStyleHsp" style=""></span>min vs&#46; 4<span class="elsevierStyleHsp" style=""></span>h 44<span class="elsevierStyleHsp" style=""></span>min and 6<span class="elsevierStyleHsp" style=""></span>h 40<span class="elsevierStyleHsp" style=""></span>min&#44; respectively&#44; p&#60;0&#46;05&#41;&#44; with shorter door-to-balloon time &#40;89<span class="elsevierStyleHsp" style=""></span>min vs&#46; 147<span class="elsevierStyleHsp" style=""></span>min and 146<span class="elsevierStyleHsp" style=""></span>min&#44; respectively&#44; p&#60;0&#46;05&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">In this population&#44; only a small proportion of patients with acute myocardial infarction underwent primary PCI within the recommended time&#46; Patients referred through the pre-hospital emergency system&#44; although a minority&#44; had the best results in terms of early treatment&#46; Compliance with the guidelines translates into better myocardial perfusion achieved through primary PCI&#46;</p>"
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        "resumen" => "<span class="elsevierStyleSectionTitle">Introdu&#231;&#227;o</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Segundo as recomenda&#231;&#245;es atuais para o tratamento do enfarte agudo do mioc&#225;rdio com supradesnivelamento do segmento ST a interven&#231;&#227;o coron&#225;ria percut&#226;nea deve ser efetuada dentro de 90<span class="elsevierStyleHsp" style=""></span>min ap&#243;s o primeiro contacto m&#233;dico e o tempo total de isqu&#233;mia n&#227;o deve exceder os 120<span class="elsevierStyleHsp" style=""></span>min&#46;</p><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">O objetivo deste trabalho foi analisar a adequa&#231;&#227;o da implementa&#231;&#227;o destas recomenda&#231;&#245;es para o enfarte do mioc&#225;rdio com supradesnivelamento do segmento ST num centro terci&#225;rio de interven&#231;&#227;o coron&#225;ria percut&#226;nea&#46;</p> <span class="elsevierStyleSectionTitle">M&#233;todos</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Registo prospetivo de centro &#250;nico de 223 doentes consecutivos referenciados para interven&#231;&#227;o coron&#225;ria percut&#226;nea prim&#225;ria entre 2003 e 2007&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Nesta popula&#231;&#227;o &#40;idade m&#233;dia 60<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12 anos&#44; 76&#37; de sexo masculino&#41;&#44; a mediana do tempo total de isqu&#233;mia foi 4<span class="elsevierStyleHsp" style=""></span>h 30<span class="elsevierStyleHsp" style=""></span>min &#40;&#60;120<span class="elsevierStyleHsp" style=""></span>min em 4&#37; dos doentes&#41;&#46; O intervalo de tempo com menor atraso foi desde o primeiro contacto m&#233;dico at&#233; &#224; realiza&#231;&#227;o do ECG &#40;mediana 8<span class="elsevierStyleHsp" style=""></span>min&#44; &#60;10<span class="elsevierStyleHsp" style=""></span>min em 59&#37; dos doentes&#41;&#46; Os intervalos com maior atraso foram&#58; do in&#237;cio dos sintomas ao primeiro contacto m&#233;dico &#40;mediana 104<span class="elsevierStyleHsp" style=""></span>min&#44; &#60;30<span class="elsevierStyleHsp" style=""></span>min em 6&#37; dos doentes&#41; e do primeiro ECG &#224; realiza&#231;&#227;o da interven&#231;&#227;o coron&#225;ria &#40;mediana 140<span class="elsevierStyleHsp" style=""></span>min&#44; &#60;90<span class="elsevierStyleHsp" style=""></span>min em 16&#37; dos doentes&#41;&#46; O menor tempo total de isqu&#233;mia associou-se a melhor fluxo TIMI final&#44; melhor TIMI <span class="elsevierStyleItalic">frame count</span> final e maior resolu&#231;&#227;o do segmento ST ap&#243;s angioplastia &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;03&#41;&#46;</p><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">As 3 origens mais frequentes dos doentes foram&#58; 2 hospitais de localidades pr&#243;ximas e o sistema de emerg&#234;ncia m&#233;dica pr&#233;-hospitalar&#46; No grupo pr&#233;-hospitalar verificou-se menor tempo total de isqu&#233;mia que nos hospitais A ou B &#40;2<span class="elsevierStyleHsp" style=""></span>h 45<span class="elsevierStyleHsp" style=""></span>min versus 4<span class="elsevierStyleHsp" style=""></span>h 44<span class="elsevierStyleHsp" style=""></span>min e 6<span class="elsevierStyleHsp" style=""></span>h 40<span class="elsevierStyleHsp" style=""></span>min&#44; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#44; com menor tempo desde o primeiro contacto m&#233;dico at&#233; &#224; angioplastia &#40;89<span class="elsevierStyleHsp" style=""></span>min versus 147 e 146<span class="elsevierStyleHsp" style=""></span>min&#44; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Conclus&#227;o</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Nesta popula&#231;&#227;o&#44; apenas uma reduzida percentagem de doentes com enfarte agudo do mioc&#225;rdio obteve tratamento adequado por angioplastia prim&#225;ria dentro dos tempos recomendados&#46; Os doentes referenciados pelo sistema de emerg&#234;ncia pr&#233;-hospitalar&#44; embora em reduzida percentagem do total&#44; foram os que obtiveram os melhores resultados na precocidade do tratamento&#46; O cumprimento das recomenda&#231;&#245;es traduz-se em melhores resultados na perfus&#227;o mioc&#225;rdica obtida pela angioplastia prim&#225;ria&#46;</p>"
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        "nota" => "<p class="elsevierStyleNotepara">Please cite this article as&#58; Sousa&#44; P&#46; ICP prim&#225;ria no enfarte de mioc&#225;rdio com supradesnivelamento do segmento ST&#58; tempo para interven&#231;&#227;o e modos de referencia&#231;&#227;o&#46; Rev Port Cardiol&#46; 2012&#46; <span class="elsevierStyleInterRef" href="doi:10.1016/j.repc.2012.07.006">doi&#58;10&#46;1016&#47;j&#46;repc&#46;2012&#46;07&#46;006</span></p>"
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          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Median total time and other time intervals in the overall population compared with maximum recommended times&#46; ECG-to-PCI center&#58; diagnostic ECG to arrival at PCI-capable center&#59; FMC-to-ECG&#58; first medical contact to diagnostic ECG&#59; Pain-to-FMC&#58; symptom onset to first medical contact&#59; PCI center-to-balloon&#58; arrival at PCI-capable center to first balloon inflation&#59; Recommended&#58; maximum recommended time&#46;</p>"
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          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Median total and other time intervals compared with maximum recommended times according to patient origin&#46; ECG-to-PCI center&#58; diagnostic ECG to arrival at PCI-capable center&#59; FMC-to-ECG&#58; first medical contact to diagnostic ECG&#59; Pain-to-FMC&#58; symptom onset to first medical contact&#59; PCI center-to-balloon&#58; arrival at PCI-capable center to first balloon inflation&#59; Pre-hosp&#58; pre-hospital emergency system&#59; Recommended&#58; maximum recommended time&#46;</p>"
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          "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Means of patient transport to first non-PCI capable hospital&#46; Ambulance&#58; ambulance without doctor &#40;pre-hospital emergency system or private transport&#41;&#46;</p>"
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&#60; Max RT &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pain-to-FMC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0<span class="elsevierStyleHsp" style=""></span>h 30<span class="elsevierStyleHsp" style=""></span>min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1<span class="elsevierStyleHsp" style=""></span>h 45<span class="elsevierStyleHsp" style=""></span>min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">FMC-to-ECG&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0<span class="elsevierStyleHsp" style=""></span>h 10<span class="elsevierStyleHsp" style=""></span>min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0<span class="elsevierStyleHsp" style=""></span>h 08<span class="elsevierStyleHsp" style=""></span>min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">58&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ECG-to-PCI center&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0<span class="elsevierStyleHsp" style=""></span>h 30<span class="elsevierStyleHsp" style=""></span>min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1<span class="elsevierStyleHsp" style=""></span>h 34<span class="elsevierStyleHsp" style=""></span>min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PCI center-to-balloon&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0<span class="elsevierStyleHsp" style=""></span>h 50<span class="elsevierStyleHsp" style=""></span>min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0<span class="elsevierStyleHsp" style=""></span>h 30<span class="elsevierStyleHsp" style=""></span>min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">75&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ECG-to-balloon&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1<span class="elsevierStyleHsp" style=""></span>h 20<span class="elsevierStyleHsp" style=""></span>min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2<span class="elsevierStyleHsp" style=""></span>h 03<span class="elsevierStyleHsp" style=""></span>min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">FMC-to-balloon&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1<span class="elsevierStyleHsp" style=""></span>h 30<span class="elsevierStyleHsp" style=""></span>min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2<span class="elsevierStyleHsp" style=""></span>h 20<span class="elsevierStyleHsp" style=""></span>min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Total ischemic time&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2<span class="elsevierStyleHsp" style=""></span>h 00<span class="elsevierStyleHsp" style=""></span>min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4<span class="elsevierStyleHsp" style=""></span>h 30<span class="elsevierStyleHsp" style=""></span>min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab268606.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Median times in the overall population compared to maximum recommended times&#46;</p>"
        ]
      ]
      4 => array:7 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">ECG-to-balloon&#58; diagnostic ECG to first balloon inflation&#59; ECG-to-PCI center&#58; diagnostic ECG to arrival at PCI-capable center&#59; FMC-to-balloon&#58; first medical contact to first balloon inflation&#59; FMC-to-ECG&#58; first medical contact to diagnostic ECG&#59;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Max RT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Pre-hospital</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Hospital A</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Hospital B</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Observed&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&#60; Max RT &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Observed&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&#60; Max RT &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Observed&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&#60; Max RT &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pain-to-FMC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0<span class="elsevierStyleHsp" style=""></span>h 30<span class="elsevierStyleHsp" style=""></span>min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1<span class="elsevierStyleHsp" style=""></span>h 15<span class="elsevierStyleHsp" style=""></span>min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1<span class="elsevierStyleHsp" style=""></span>h 47<span class="elsevierStyleHsp" style=""></span>min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2<span class="elsevierStyleHsp" style=""></span>h 32<span class="elsevierStyleHsp" style=""></span>min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">FMC-to-ECG&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0<span class="elsevierStyleHsp" style=""></span>h 10<span class="elsevierStyleHsp" style=""></span>min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0<span class="elsevierStyleHsp" style=""></span>h 07<span class="elsevierStyleHsp" style=""></span>min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">71&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0<span class="elsevierStyleHsp" style=""></span>h 13<span class="elsevierStyleHsp" style=""></span>min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">48&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0<span class="elsevierStyleHsp" style=""></span>h 06<span class="elsevierStyleHsp" style=""></span>min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">64&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ECG-to-PCI center&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0<span class="elsevierStyleHsp" style=""></span>h 30<span class="elsevierStyleHsp" style=""></span>min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0<span class="elsevierStyleHsp" style=""></span>h 36<span class="elsevierStyleHsp" style=""></span>min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1<span class="elsevierStyleHsp" style=""></span>h 46<span class="elsevierStyleHsp" style=""></span>min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1<span class="elsevierStyleHsp" style=""></span>h 39<span class="elsevierStyleHsp" style=""></span>min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PCI center-to-balloon&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0<span class="elsevierStyleHsp" style=""></span>h 50<span class="elsevierStyleHsp" style=""></span>min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0<span class="elsevierStyleHsp" style=""></span>h 44<span class="elsevierStyleHsp" style=""></span>min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">62&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0<span class="elsevierStyleHsp" style=""></span>h 27<span class="elsevierStyleHsp" style=""></span>min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">88&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0<span class="elsevierStyleHsp" style=""></span>h 24<span class="elsevierStyleHsp" style=""></span>min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">84&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ECG-to-balloon&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1<span class="elsevierStyleHsp" style=""></span>h 20<span class="elsevierStyleHsp" style=""></span>min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1<span class="elsevierStyleHsp" style=""></span>h 22<span class="elsevierStyleHsp" style=""></span>min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">50&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2<span class="elsevierStyleHsp" style=""></span>h 20<span class="elsevierStyleHsp" style=""></span>min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">6&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2<span class="elsevierStyleHsp" style=""></span>h 22<span class="elsevierStyleHsp" style=""></span>min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">FMC-to-balloon&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1<span class="elsevierStyleHsp" style=""></span>h 30<span class="elsevierStyleHsp" style=""></span>min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1<span class="elsevierStyleHsp" style=""></span>h 29<span class="elsevierStyleHsp" style=""></span>min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">64&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2<span class="elsevierStyleHsp" style=""></span>h 27<span class="elsevierStyleHsp" style=""></span>min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2<span class="elsevierStyleHsp" style=""></span>h 26<span class="elsevierStyleHsp" style=""></span>min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">4&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Total ischemic time&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2<span class="elsevierStyleHsp" style=""></span>h 00<span class="elsevierStyleHsp" style=""></span>min&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2<span class="elsevierStyleHsp" style=""></span>h 45<span class="elsevierStyleHsp" style=""></span>min&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">6&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4<span class="elsevierStyleHsp" style=""></span>h 44<span class="elsevierStyleHsp" style=""></span>min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">1&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6<span class="elsevierStyleHsp" style=""></span>h 40<span class="elsevierStyleHsp" style=""></span>min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#46;0&nbsp;\t\t\t\t\t\t\n
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                  """
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          "en" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Median times compared to maximum recommended times according to patient origin&#46;</p>"
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            0 => array:2 [
              "tabla" => array:1 [
                0 => """
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Total ischemic time&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">TIMI 2 vs&#46; 3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">7 h 03<span class="elsevierStyleHsp" style=""></span>min vs&#46; 4<span class="elsevierStyleHsp" style=""></span>h 17<span class="elsevierStyleHsp" style=""></span>min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;02&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">TIMI frame count &#62;24 vs&#46; &#8804;24&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">5 h 00<span class="elsevierStyleHsp" style=""></span>min vs&#46; 4<span class="elsevierStyleHsp" style=""></span>h 11<span class="elsevierStyleHsp" style=""></span>min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#46;03&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">ST resolution &#60;70&#37; vs&#46; &#8805;70&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">5 h 12<span class="elsevierStyleHsp" style=""></span>min vs&#46; 3<span class="elsevierStyleHsp" style=""></span>h 59<span class="elsevierStyleHsp" style=""></span>min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#46;002&nbsp;\t\t\t\t\t\t\n
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                  """
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    ]
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      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:18 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Primary angioplasty versus intravenous thrombolytic therapy for acute myocardial infarction&#58; a quantitative review of 23 randomised trials"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "E&#46;C&#46; Keeley"
                            1 => "J&#46;A&#46; Boura"
                            2 => "C&#46;L&#46; Grines"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S0140-6736(03)12113-7"
                      "Revista" => array:6 [
                        "tituloSerie" => "Lancet"
                        "fecha" => "2003"
                        "volumen" => "361"
                        "paginaInicial" => "13"
                        "paginaFinal" => "20"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12517460"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Association of door-to-balloon time and mortality in patients admitted to hospital with ST elevation myocardial infarction&#58; national cohort study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "S&#46;S&#46; Rathore"
                            1 => "J&#46;P&#46; Curtis"
                            2 => "J&#46; Chen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "BMJ"
                        "fecha" => "2009"
                        "volumen" => "338"
                        "paginaInicial" => "b1807"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19454739"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Time delay to treatment and mortality in primary angioplasty for acute myocardial infarction&#58; every minute of delay counts"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "G&#46; De Luca"
                            1 => "H&#46; Suryapranata"
                            2 => "J&#46;P&#46; Ottervanger"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/01.CIR.0000121424.76486.20"
                      "Revista" => array:6 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "2004"
                        "volumen" => "109"
                        "paginaInicial" => "1223"
                        "paginaFinal" => "1225"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15007008"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Management of acute myocardial infarction in patients presenting with persistent ST-segment elevation&#58; the Task Force on the Management of ST-Segment Elevation Acute Myocardial Infarction of the European Society of Cardiology"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "F&#46; Van de Werf"
                            1 => "J&#46; Bax"
                            2 => "A&#46; Betriu"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Eur Heart J"
                        "fecha" => "2008"
                        "paginaInicial" => "2909"
                        "paginaFinal" => "2945"
                      ]
                    ]
                  ]
                ]
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                      "titulo" => "A citywide protocol for primary PCI in ST-segment elevation myocardial infarction"
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Article information

ISSN: 21742049
Original language: English

DOI:10.1016/j.repce.2012.08.001

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2019 March	131	8	139
2019 February	137	9	146
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2018 March	201	9	210
2018 February	94	8	102
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2017 October	56	9	65
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2017 July	31	6	37
2017 June	60	9	69
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2014 September	44	18	62
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2014 March	73	20	93
2014 February	59	23	82
2014 January	70	18	88
2013 December	62	18	80
2013 November	64	22	86
2013 October	58	15	73
2013 September	72	22	94
2013 August	73	13	86
2013 July	79	20	99
2013 June	51	11	62
2013 May	62	15	77
2013 April	85	32	117
2013 March	61	19	80
2013 February	69	26	95
2013 January	78	28	106
2012 December	52	26	78
2012 November	44	33	77
2012 October	52	25	77

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