Original article
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
Impacto da via verde coronária e da angioplastia primária na redução da mortalidade associada ao enfarte com elevação do segmento ST anterior. A experiência algarvia
Nuno Marques
, Ricardo Faria, Pedro Sousa, Jorge Mimoso, Victor Brandão, Veloso Gomes, Ilídio Jesus
Corresponding author
Serviço de Cardiologia, Hospital de Faro, EPE, Faro, Portugal
Read
8261
Timeswas read the article
2122
Total PDF
6139
Total HTML
Share statistics
array:25 [ "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" "copyrightAnyo" => "2011" "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 ] ] "Traduccion" => array:1 [ "pt" => array:20 [ "pii" => "S0870255112001771" "issn" => "08702551" "doi" => "10.1016/j.repc.2012.07.005" "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;31:647-54" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 8409 "formatos" => array:3 [ "EPUB" => 205 "HTML" => 6649 "PDF" => 1555 ] ] "pt" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Artigo original</span>" "titulo" => "Impacto da via verde coronária e da angioplastia primária na redução da mortalidade associada ao enfarte com elevação do segmento ST anterior. A experiência algarvia" "tienePdf" => "pt" "tieneTextoCompleto" => "pt" "tieneResumen" => array:2 [ 0 => "pt" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "647" "paginaFinal" => "654" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "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" ] ] "contieneResumen" => array:2 [ "pt" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "pt" => true ] "contienePdf" => array:1 [ "pt" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 765 "Ancho" => 2149 "Tamanyo" => 86168 ] ] "descripcion" => array:1 [ "pt" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Distribuição mensal dos doentes com EAMCST anterior ao longo do ano de 2008.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Nuno Marques, Ricardo Faria, Pedro Sousa, Jorge Mimoso, Victor Brandão, Veloso Gomes, Ilídio Jesus" "autores" => array:7 [ 0 => array:2 [ "nombre" => "Nuno" "apellidos" => "Marques" ] 1 => array:2 [ "nombre" => "Ricardo" "apellidos" => "Faria" ] 2 => array:2 [ "nombre" => "Pedro" "apellidos" => "Sousa" ] 3 => array:2 [ "nombre" => "Jorge" "apellidos" => "Mimoso" ] 4 => array:2 [ "nombre" => "Victor" "apellidos" => "Brandão" ] 5 => array:2 [ "nombre" => "Veloso" "apellidos" => "Gomes" ] 6 => array:2 [ "nombre" => "Ilídio" "apellidos" => "Jesus" ] ] ] ] ] "idiomaDefecto" => "pt" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2174204912001407" "doi" => "10.1016/j.repce.2012.08.002" "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/S2174204912001407?idApp=UINPBA00004E" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255112001771?idApp=UINPBA00004E" "url" => "/08702551/0000003100000010/v1_201308021325/S0870255112001771/v1_201308021325/pt/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2174204912001560" "issn" => "21742049" "doi" => "10.1016/j.repce.2012.09.001" "estado" => "S300" "fechaPublicacion" => "2012-10-01" "aid" => "146" "copyright" => "Sociedade Portuguesa de Cardiologia" "documento" => "article" "crossmark" => 0 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "ssu" "cita" => "Rev Port Cardiol. 2012;31:655-60" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 4599 "formatos" => array:3 [ "EPUB" => 146 "HTML" => 3755 "PDF" => 698 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Review article</span>" "titulo" => "Natriuretic peptides in aortic stenosis" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "pt" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "655" "paginaFinal" => "660" ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Peptídeos natriuréticos na estenose aórtica" ] ] "contieneResumen" => array:2 [ "en" => true "pt" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "Adapted from Bergler-Klein.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a>" "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 760 "Ancho" => 1667 "Tamanyo" => 107079 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Release of BNP into the circulation from cardiac myocytes via precursor hormones. aa: amino acids.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Paulo Torres-Ramalho, José Paulo Araújo, Paulo Bettencourt, Luís M. Moura" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Paulo" "apellidos" => "Torres-Ramalho" ] 1 => array:2 [ "nombre" => "José Paulo" "apellidos" => "Araújo" ] 2 => array:2 [ "nombre" => "Paulo" "apellidos" => "Bettencourt" ] 3 => array:2 [ "nombre" => "Luís M." "apellidos" => "Moura" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204912001560?idApp=UINPBA00004E" "url" => "/21742049/0000003100000010/v1_201305151709/S2174204912001560/v1_201305151709/en/main.assets" ] "itemAnterior" => array:20 [ "pii" => "S2174204912001390" "issn" => "21742049" "doi" => "10.1016/j.repce.2012.08.001" "estado" => "S300" "fechaPublicacion" => "2012-10-01" "aid" => "150" "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;31:641-6" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 6916 "formatos" => array:3 [ "EPUB" => 134 "HTML" => 5711 "PDF" => 1071 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Primary PCI in ST-elevation myocardial infarction: Mode of referral and time to PCI" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "pt" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "641" "paginaFinal" => "646" ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "ICP primária no enfarte de miocárdio com supradesnivelamento do segmento ST: tempo para intervenção e modos de referenciação" ] ] "contieneResumen" => array:2 [ "en" => true "pt" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => 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" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">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.</p>" ] ] ] "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" => "en" "Traduccion" => array:1 [ "pt" => array:9 [ "pii" => "S0870255112001783" "doi" => "10.1016/j.repc.2012.07.006" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "pt" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255112001783?idApp=UINPBA00004E" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204912001390?idApp=UINPBA00004E" "url" => "/21742049/0000003100000010/v1_201305151709/S2174204912001390/v1_201305151709/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "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" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "647" "paginaFinal" => "653" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Nuno Marques, Ricardo Faria, Pedro Sousa, Jorge Mimoso, Victor Brandão, Veloso Gomes, Ilídio Jesus" "autores" => array:7 [ 0 => array:4 [ "nombre" => "Nuno" "apellidos" => "Marques" "email" => array:1 [ 0 => "nunomarques@spc.pt" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Ricardo" "apellidos" => "Faria" ] 2 => array:2 [ "nombre" => "Pedro" "apellidos" => "Sousa" ] 3 => array:2 [ "nombre" => "Jorge" "apellidos" => "Mimoso" ] 4 => array:2 [ "nombre" => "Victor" "apellidos" => "Brandão" ] 5 => array:2 [ "nombre" => "Veloso" "apellidos" => "Gomes" ] 6 => array:2 [ "nombre" => "Ilídio" "apellidos" => "Jesus" ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Serviço de Cardiologia, Hospital de Faro, EPE, Faro, Portugal" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "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. A experiência algarvia" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 833 "Ancho" => 1146 "Tamanyo" => 48054 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Distribution of patients by Killip class at admission.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Primary angioplasty has been shown to be superior to fibrinolytic therapy in ST-elevation myocardial infarction (STEMI) and is indicated as first-line treatment in the guidelines.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The shorter the time interval between symptom onset (or first medical contact) and angioplasty, the greater its benefit. In order to minimize this interval, a coronary fast-track system (<span class="elsevierStyleItalic">Via Verde Coronária</span>) has been established in the Algarve region of Portugal to provide rapid and efficient transport between the pre-hospital setting and a hospital able to perform primary angioplasty or to transfer a patient from one hospital to another with the necessary facilities. The time from first medical contact to primary angioplasty (medical contact-to-balloon time) should be less than 120 minutes, except in patients presenting with extensive infarction within two hours of symptom onset and with a low bleeding risk, when it should be less than 90 minutes.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The Portuguese region of the Algarve has a resident population of around 500<span class="elsevierStyleHsp" style=""></span>000, which can increase threefold due to tourism, especially in the summer. Faro Hospital is the only hospital in the region able to provide 24-hour primary angioplasty, and has a coronary care unit (CCU) with the logistic and technical facilities to treat STEMI patients. It is part of a referral network, the coronary fast-track system, which is designed to ensure that all STEMI patients originating from the National Institute for Medical Emergencies (INEM) system or health centers, basic emergency departments or Hospital do Barlavento Algarvio (which does not have primary angioplasty capability) are transferred immediately to Faro Hospital for primary angioplasty.</p><p id="par0020" class="elsevierStylePara elsevierViewall">INEM, basic emergency departments and Hospital do Barlavento Algarvio have 24-hour facilities to perform 12-lead ECG and transmit the data to the CCU in Faro Hospital; the coronary fast-track system is activated by a telephone call from the cardiologist on duty.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The coronary fast-track system began operating in the Algarve in 2002, since when it has been the means of referral for a growing number of STEMI patients. Primary angioplasty has been available in Faro Hospital since 2003 and a large number of procedures are performed every year.</p><p id="par0030" class="elsevierStylePara elsevierViewall">With the exception of the Algarve region, fewer than 6% of STEMI patients in Portugal treated by primary angioplasty are referred directly by local fast-track systems.</p><p id="par0035" class="elsevierStylePara elsevierViewall">In patients with anterior STEMI it is particularly important to select and implement the appropriate treatment as rapidly as possible in order to reduce their high mortality. Figures in the literature vary, but 30-day mortality is over 6%.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4–6</span></a> In Portugal no outcome data have been published for anterior STEMI in centers with primary angioplasty facilities linked to a coronary fast-track system.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The aim of this study was to analyze and present the results of a center with direct access to primary angioplasty and with several years’ experience of a coronary fast-track system in the management of patients admitted with anterior STEMI in 2008.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Study population</span><p id="par0045" class="elsevierStylePara elsevierViewall">The study included 120 patients admitted with anterior STEMI to Faro Hospital in 2008.</p><p id="par0050" class="elsevierStylePara elsevierViewall">The diagnosis of anterior STEMI was based on 12-lead ECG, using the criteria of ST-segment elevation ≥0.1<span class="elsevierStyleHsp" style=""></span>mV in DI and aVL or ≥0.2<span class="elsevierStyleHsp" style=""></span>mV in two or more contiguous precordial leads from V1 to V5. All patients who met the ECG criteria and presented sustained chest pain of less than 12 hours’ duration were included. The diagnosis of anterior STEMI was established by a physician from INEM, a health center, basic emergency departments, the Emergency Department of Hospital do Barlavento Algarvio or the Emergency Department of Faro Hospital.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Coronary fast-track system and treatment protocol</span><p id="par0055" class="elsevierStylePara elsevierViewall">The coronary fast-track system functions as follows:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">-</span><p id="par0060" class="elsevierStylePara elsevierViewall">Patients who used the national medical emergency number (112) and whose diagnosis was established by an INEM physician were transported directly to the catheterization and interventional cardiology laboratory (LHCI) of Faro Hospital, the CCU physician having been contacted by telephone.</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">-</span><p id="par0065" class="elsevierStylePara elsevierViewall">Patients who went to health centers, basic emergency departments, or the Emergency Department of Hospital do Barlavento Algarvio underwent ECG, which was transmitted via the Lifenet system to the CCU in Faro Hospital; telephone contact was immediately established between the receiving institution and the cardiologist on duty at the CCU, and transfer of the patient to the LHCI, accompanied by a physician from INEM or the receiving institution, was arranged.</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">-</span><p id="par0070" class="elsevierStylePara elsevierViewall">Patients who went directly to the Emergency Department of Faro Hospital were immediately transferred under medical supervision to the LHCI (or to the CCU while awaiting access to the LHCI) after contact between the emergency department physician and the cardiologist on duty at the CCU. These patients were not considered to have been admitted via the fast-track system.</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">-</span><p id="par0075" class="elsevierStylePara elsevierViewall">Irrespective of how the fast-track system was activated, the cardiologist on duty at the CCU immediately contacted the catheterization team to ensure that they would be available when the patient arrived in the department.</p></li></ul></p><p id="par0080" class="elsevierStylePara elsevierViewall">During transfer of patients to the LHCI, 250<span class="elsevierStyleHsp" style=""></span>mg of aspirin and oxygen therapy were administered. Clopidogrel was not usually administered, but depending on symptoms and in the absence of contraindications, opioids, metoclopramide, diazepam or nitrates could be given. Hemodynamically unstable patients were given fluids and inotropic agents at the discretion of the accompanying physician. Arrhythmias were treated in accordance with established practice with amiodarone or electrical cardioversion. Patients suffering cardiopulmonary arrest (CPA) were resuscitated in accordance with international guidelines.</p><p id="par0085" class="elsevierStylePara elsevierViewall">Radial access was used by preference in the LHCI after administration of 5000<span class="elsevierStyleHsp" style=""></span>U of unfractionated heparin. A single 20-mg bolus of eptifibatide was administered during the procedure. Stenting was used in most cases, the type of stent being at the discretion of the interventional cardiologist, who also decided whether intracoronary thrombus aspiration was required. Following the intervention, 600<span class="elsevierStyleHsp" style=""></span>mg of clopidogrel was administered.</p><p id="par0090" class="elsevierStylePara elsevierViewall">Patients were then transferred to the CCU and treated according to international guidelines for STEMI.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">After clinical stabilization, patients were transferred to the cardiology ward under continuous telemetric ECG monitoring until discharge. During hospitalization patients were enrolled in the Cardiology Department's cardiac rehabilitation program.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Data collection and processing</span><p id="par0100" class="elsevierStylePara elsevierViewall">Data were collected retrospectively by consulting the LHCI database, the Cardiology Department's acute coronary syndromes database, and the medical support system of Faro Hospital. The medical records of individual patients were also consulted when necessary.</p><p id="par0105" class="elsevierStylePara elsevierViewall">Demographic data, personal history, cardiovascular risk factors, clinical presentation, method of activation of the fast-track system, time intervals, type of access, results of coronary angiography and types of stent used were recorded.</p><p id="par0110" class="elsevierStylePara elsevierViewall">The following time intervals were defined:<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">-</span><p id="par0115" class="elsevierStylePara elsevierViewall">Pain-to-diagnosis (from onset of pain to first ECG);</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">-</span><p id="par0120" class="elsevierStylePara elsevierViewall">Pain-to-balloon (from onset of pain to first balloon inflation);</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">-</span><p id="par0125" class="elsevierStylePara elsevierViewall">Diagnosis-to-balloon (from first ECG to first balloon inflation);</p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">-</span><p id="par0130" class="elsevierStylePara elsevierViewall">Door-to-balloon (from arrival at Faro Hospital to first balloon inflation).</p></li></ul></p><p id="par0135" class="elsevierStylePara elsevierViewall">The TIMI risk score for STEMI was calculated for each patient to determine predicted mortality.</p><p id="par0140" class="elsevierStylePara elsevierViewall">Patients were followed at 30 days through consultations or telephone interviews.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Statistical analysis</span><p id="par0145" class="elsevierStylePara elsevierViewall">SPSS version 13.0 was used for the statistical analysis. The Kolmogorov–Smirnov test was used to assess data normality, and the variables were analyzed accordingly. Descriptive variables are presented as median or mean<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>standard deviation as appropriate. Mortality was compared using Pearson's correlation coefficient, with a level of significance of p<0.05.</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Results</span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Characteristics of the study population</span><p id="par0150" class="elsevierStylePara elsevierViewall">During 2008, 120 patients were admitted to the Cardiology Department of Faro Hospital with a diagnosis of anterior STEMI. Of these, 21 (17.5%) did not present significant coronary stenosis, and the following data refer to the 99 patients who did have significant coronary disease.</p><p id="par0155" class="elsevierStylePara elsevierViewall">Of these 99 patients, 79 were male and 20 female.</p><p id="par0160" class="elsevierStylePara elsevierViewall">The mean number of patients with anterior STEMI admitted per month was eight, ranging between four in October and November and 12 in March (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0165" class="elsevierStylePara elsevierViewall">Their mean age was 63±13 years (33–85); 29% were aged between 65 and 79 and 14% were aged ≥80.</p><p id="par0170" class="elsevierStylePara elsevierViewall">Patients’ clinical histories are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0175" class="elsevierStylePara elsevierViewall">Six patients suffered CPA before hospital arrival requiring resuscitation maneuvers, and seven presented with cardiogenic shock (defined as systolic blood pressure <90<span class="elsevierStyleHsp" style=""></span>mmHg and/or need for inotropic support), but most (71%) were in Killip class I at admission (<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0180" class="elsevierStylePara elsevierViewall">Most patients (55%) had a TIMI risk score for STEMI of >4 (<a class="elsevierStyleCrossRef" href="#fig0015">Figure 3</a>).</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Patient origin</span><p id="par0185" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#fig0020">Figure 4</a> shows the origin of patients, the largest proportion coming from Hospital Barlavento Algarvio (31%) and basic emergency departments/health centers (25%).</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Time intervals following symptom onset</span><p id="par0190" class="elsevierStylePara elsevierViewall">Median pain-to-diagnosis time was 162 minutes (<3<span class="elsevierStyleHsp" style=""></span>hours), median diagnosis-to-balloon time was 89 minutes and median door-to-balloon time was 15 minutes (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0195" class="elsevierStylePara elsevierViewall">Most patients underwent primary angioplasty within six hours of symptom onset (36% within three hours and 46% between three and six hours).</p><p id="par0200" class="elsevierStylePara elsevierViewall">Diagnosis-to-balloon time was <120 minutes in 80% of patients but was longer in patients arriving via Hospital Barlavento Algarvio (<a class="elsevierStyleCrossRef" href="#fig0025">Figure 5</a>).</p><elsevierMultimedia ident="fig0025"></elsevierMultimedia><p id="par0205" class="elsevierStylePara elsevierViewall">The coronary fast-track system was obviously not activated for patients who went directly to the Emergency Department of Faro Hospital. Of those who did not, the fast-track system was not activated in only three cases (4%) (<a class="elsevierStyleCrossRef" href="#fig0030">Figure 6</a>.)</p><elsevierMultimedia ident="fig0030"></elsevierMultimedia></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Interventions in the catheterization laboratory</span><p id="par0210" class="elsevierStylePara elsevierViewall">Radial access was used in 82% of cases. Multivessel coronary disease was detected in 50% of patients. Complete revascularization was achieved in the initial procedure in 83% of cases. A mean of 2.1 stents were used, with drug-eluting stents being used in 81% of patients (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>).</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0215" class="elsevierStylePara elsevierViewall">The failure rate of primary angioplasty was 2%.</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Mortality and reinfarction</span><p id="par0220" class="elsevierStylePara elsevierViewall">During hospital stay there were two deaths from cardiovascular causes and one non-cardiovascular death (from septicemia secondary to acute cholecystitis). Overall mortality was thus 3% (<a class="elsevierStyleCrossRef" href="#fig0035">Figure 7</a>). The patients who died during hospital stay had a TIMI risk score for STEMI of ≥7.</p><elsevierMultimedia ident="fig0035"></elsevierMultimedia><p id="par0225" class="elsevierStylePara elsevierViewall">No other deaths occurred during follow-up and thus 30-day mortality was 3%. The predicted mortality based on the TIMI risk score was 14%, considerably higher than observed (p<0.01) (<a class="elsevierStyleCrossRef" href="#fig0035">Figure 7</a>).</p><p id="par0230" class="elsevierStylePara elsevierViewall">Mortality was higher in women (5% vs. 2.5%), although without statistical significance. In patients who presented with cardiogenic shock mortality was significantly higher (28.6%) (p<0.01), as it was in very elderly patients (aged ≥80) (p<0.01) (<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>).</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0235" class="elsevierStylePara elsevierViewall">Radial access was associated with significantly lower mortality (1.2% vs. 11.1%, p=0.03), while complete revascularization did not increase mortality (2.4% vs. 5.9%, p=NS).</p><p id="par0240" class="elsevierStylePara elsevierViewall">There were no instances of reinfarction during hospital stay.</p></span></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discussion</span><p id="par0245" class="elsevierStylePara elsevierViewall">Primary angioplasty is indicated as a priority in patients with STEMI and should be performed as early as possible. Fibrinolytic therapy has similar results to primary angioplasty when administered within 120 minutes of pain onset, but is associated with considerably higher risk of bleeding, particularly hemorrhagic stroke.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7,8</span></a> Prompt transfer to a hospital with facilities for primary angioplasty avoids exposing patients to the risk of fibrinolysis, which should only be considered when there is no possibility of primary angioplasty within 120 minutes. According to the American and European guidelines, the interval between diagnosis and balloon angioplasty should not exceed 120 minutes and ideally should be less than 90 minutes.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–3</span></a></p><p id="par0250" class="elsevierStylePara elsevierViewall">However, the first relevant time interval – between symptom onset and first medical contact – basically depends on the patient. In our study, the median pain-to-diagnosis time of 162 minutes is longer than reported in the registries presented by Flesch et al. (Cologne)<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> and Le May et al.,<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> which highlights the need for public education programs to encourage earlier use of the medical emergency telephone number.</p><p id="par0255" class="elsevierStylePara elsevierViewall">The benefit of a coronary fast-track system is mainly a function of its ability to transfer patients diagnosed with STEMI to a hospital with facilities for primary angioplasty. Analysis of the graph showing diagnosis-to-balloon times according to patient origin (<a class="elsevierStyleCrossRef" href="#fig0025">Figure 5</a>) reveals that the longest time was for patients from Hospital Barlavento Algarvio, which can be explained by its distance from Faro Hospital (over 60<span class="elsevierStyleHsp" style=""></span>km) and the fact that INEM does not transfer patients between hospitals. However, this problem is mitigated by the round-the-clock availability of an on-site ambulance and team prepared for immediate interhospital transfer. Although they could be improved, our diagnosis-to-balloon times were shorter than those reported in other registries of urban areas with several hospitals with facilities for primary angioplasty.<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10,11</span></a> The fact that 80% of patients were treated within the time limits recommended in the guidelines shows that it is possible to develop an efficient system to transfer patients for primary angioplasty.</p><p id="par0260" class="elsevierStylePara elsevierViewall">Our door-to-balloon times were also shorter than those in other studies and registries,<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10–12</span></a> proof of the excellent organization of the LHCI and the technical skills of the angioplasty team, in which the experience of the interventional cardiologist (who performs around 200 primary angioplasties a year) is a key factor.</p><p id="par0265" class="elsevierStylePara elsevierViewall">The rate of activation of the fast-track system was high (74% of all anterior STEMI patients), which reflects the continuing improvements to the system over the several years it has been operating. The fact that 23% of patients still went directly to the Emergency Department of Faro Hospital may indicate that further campaigns to raise public awareness are required.</p><p id="par0270" class="elsevierStylePara elsevierViewall">The distribution of patients over the course of the year was relatively constant, with a slight increase in the months when more tourists come to the Algarve (summer, Easter and New Year). The characteristics of the study population are similar to those found in other studies;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10,11</span></a> the high percentage of elderly patients (43% aged over 65), the number who suffered CPA (seven) and the number presenting with cardiogenic shock (six) should be noted. A TIMI risk score of ≥4 in 55% of patients is a clear indication of the high risk of patients with anterior STEMI.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> This percentage is higher than found in other studies, which may be related to the fact that the analysis focused solely on anterior STEMI.<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10,11</span></a></p><p id="par0275" class="elsevierStylePara elsevierViewall">A radial approach was used in a higher percentage (82% of the study population) than reported in other registries, even in those of highly experienced centers such as in Ruzsa et al.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> Radial access is generally considered to be better for angioplasty due to the lower rate of bleeding complications.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> It has, however, frequently been pointed out that it should only be used in centers with considerable experience in angiography and elective angioplasty using this approach, so as to avoid delays in revascularizing patients with STEMI. The LHCI at Faro Hospital has performed a large number of procedures using radial access and thus conforms to this recommendation. The fact that the median time from arrival at the LHCI to first balloon inflation was 15 minutes is clear evidence of the center's efficiency in this technique.</p><p id="par0280" class="elsevierStylePara elsevierViewall">Another interesting finding was that despite the competence of those interpreting the ECGs, 20% of patients did not present significant coronary stenosis on angiography. This figure is higher than found in other registries analyzing coronary fast-track systems.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p><p id="par0285" class="elsevierStylePara elsevierViewall">The presence of multivessel disease in half of the patients is not unexpected given the characteristics of the study population. There is still disagreement concerning whether to perform complete revascularization in such patients, although some studies have shown that it is safe in primary angioplasty.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> In our study the interventional cardiologist opted for complete revascularization in 83% of cases, and no complications occurred in the short term, which appears to confirm its safety.</p><p id="par0290" class="elsevierStylePara elsevierViewall">Drug-eluting stents were used in most patients. Randomized trials on these stents have shown their non-inferiority compared to bare-metal stents in primary angioplasty.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> There is even more reason to use drug-eluting stents in anterior STEMI due to the large area of myocardium affected.</p><p id="par0295" class="elsevierStylePara elsevierViewall">Mortality in this study, both in-hospital and at 30 days (3%), was lower than reported in the literature for anterior STEMI<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4–6</span></a> and significantly lower than predicted by the TIMI risk score (14%).</p><p id="par0300" class="elsevierStylePara elsevierViewall">A limitation of the study is that it was not designed to determine the underlying causes of this lower mortality, although the authors consider that it may be related to various factors, including:<ul class="elsevierStyleList" id="lis0015"><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">-</span><p id="par0305" class="elsevierStylePara elsevierViewall">the pre-hospital emergency network, which enables rapid and efficient transport of STEMI patients via the coronary fast-track system accompanied by medical staff trained to provide advance life support;</p></li><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">-</span><p id="par0310" class="elsevierStylePara elsevierViewall">the high rate of activation of the coronary fast-track system;</p></li><li class="elsevierStyleListItem" id="lsti0055"><span class="elsevierStyleLabel">-</span><p id="par0315" class="elsevierStylePara elsevierViewall">optimized organization of the LHCI;</p></li><li class="elsevierStyleListItem" id="lsti0060"><span class="elsevierStyleLabel">-</span><p id="par0320" class="elsevierStylePara elsevierViewall">quality of care in the CCU;</p></li><li class="elsevierStyleListItem" id="lsti0065"><span class="elsevierStyleLabel">-</span><p id="par0325" class="elsevierStylePara elsevierViewall">quality of care in the cardiology ward, with continuous telemetric monitoring and enrolment in cardiac rehabilitation programs.</p></li></ul></p><p id="par0335" class="elsevierStylePara elsevierViewall">The factors associated with the observed mortality were cardiogenic shock and age over 80, as found in other studies and registries.<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10,11</span></a></p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conclusion</span><p id="par0340" class="elsevierStylePara elsevierViewall">Direct access to primary angioplasty was associated with low mortality in patients admitted with anterior STEMI.</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflicts of interest</span><p id="par0345" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:2 [ "identificador" => "xres176063" "titulo" => array:5 [ 0 => "Abstract" 1 => "Introduction" 2 => "Methods" 3 => "Results" 4 => "Conclusion" ] ] 1 => array:2 [ "identificador" => "xpalclavsec164437" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres176064" "titulo" => array:5 [ 0 => "Resumo" 1 => "Introdução" 2 => "Métodos" 3 => "Resultados" 4 => "Conclusão" ] ] 3 => array:2 [ "identificador" => "xpalclavsec164438" "titulo" => "Palavras-chave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Methods" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Study population" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Coronary fast-track system and treatment protocol" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Data collection and processing" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Statistical analysis" ] ] ] 6 => array:3 [ "identificador" => "sec0035" "titulo" => "Results" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0040" "titulo" => "Characteristics of the study population" ] 1 => array:2 [ "identificador" => "sec0045" "titulo" => "Patient origin" ] 2 => array:2 [ "identificador" => "sec0050" "titulo" => "Time intervals following symptom onset" ] 3 => array:2 [ "identificador" => "sec0055" "titulo" => "Interventions in the catheterization laboratory" ] 4 => array:2 [ "identificador" => "sec0060" "titulo" => "Mortality and reinfarction" ] ] ] 7 => array:2 [ "identificador" => "sec0065" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0070" "titulo" => "Conclusion" ] 9 => array:2 [ "identificador" => "sec0075" "titulo" => "Conflicts of interest" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2011-11-05" "fechaAceptado" => "2012-04-23" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec164437" "palabras" => array:5 [ 0 => "Anterior ST-segment elevation myocardial infarction" 1 => "Anterior infarction" 2 => "Mortality" 3 => "Coronary fast-track system" 4 => "Primary angioplasty" ] ] ] "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec164438" "palabras" => array:5 [ 0 => "Enfarte agudo do miocárdio com supradesnivelamento do segmento ST" 1 => "Enfarte anterior" 2 => "Mortalidade" 3 => "Via verde" 4 => "Angioplastia primária" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span class="elsevierStyleSectionTitle">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">There are few published data on mortality in anterior ST-segment elevation myocardial infarction (STEMI) in Portugal, particularly in centers with direct access to primary angioplasty. We present the experience of a center with direct access to primary angioplasty in the management of patients admitted with anterior STEMI.</p> <span class="elsevierStyleSectionTitle">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">We performed a retrospective study of 120 patients admitted with anterior STEMI in 2008 to Faro Hospital (Algarve region, Portugal).</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Significant coronary artery stenosis was found in 99 patients (82.5%). These patients were predominantly male (79%), and had a mean age of 63 years. Primary angioplasty was performed in the majority of patients within 6<span class="elsevierStyleHsp" style=""></span>hours of symptom onset and median ECG-to-balloon time was 89 minutes. Primary angioplasty was successful in 98% of patients and complete revascularization was achieved in 83%. Radial access was used in 82% of cases. In-hospital and 30-day mortality was 3%.</p> <span class="elsevierStyleSectionTitle">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Direct access to primary angioplasty was associated with low mortality in patients admitted with anterior STEMI.</p>" ] "pt" => array:2 [ "titulo" => "Resumo" "resumen" => "<span class="elsevierStyleSectionTitle">Introdução</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Existem muito poucos dados em Portugal sobre a mortalidade do enfarte agudo do miocárdio com supradesnivelamento do segmento ST (EAMCST) anterior, particularmente em centros com via verde coronária (VVC) e angioplastia primária. O objetivo deste estudo é apresentar os resultados de um centro com VVC e angioplastia primária no tratamento de doentes internados por EAMCST anterior.</p> <span class="elsevierStyleSectionTitle">Métodos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudo retrospetivo dos 120 doentes admitidos por EAMCST de localização anterior no ano de 2008 no centro hospitalar de Faro.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Foi encontrada doença coronária significativa em 99 doentes (82,5%). Estes doentes eram predominantemente do sexo masculino (79%) e tinham uma idade média de 63 anos. A angioplastia primária foi realizada na maioria dos doentes nas primeiras 6 h após o início dos sintomas, sendo que a mediana do tempo ECG-balão foi de 89 min. A taxa de sucesso da angioplastia primária foi de 98%, sendo que a revascularização foi completa em 83% dos casos. O cateterismo cardíaco foi realizado por via radial em 82% dos doentes. A taxa de mortalidade intra-hospitalar e aos 30 dias foi de 3%.</p> <span class="elsevierStyleSectionTitle">Conclusão</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">A implementação da VVC com acesso direto a angioplastia primária associou-se a uma baixa taxa de mortalidade dos doentes admitidos por EAMCST anterior.</p>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: Marques N, et al. Impacto da Via Verde Coronária e da Angioplastia Primária na redução da mortalidade associada ao enfarte com elevação do segmento ST anterior. A experiência Algarvia. Rev Port Cardiol. 2012. <span class="elsevierStyleInterRef" href="http://dx.doi.org/10.1016/j.repc.2012.07.005">http://dx.doi.org/10.1016/j.repc.2012.07.005</span>.</p>" ] ] "multimedia" => array:11 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 771 "Ancho" => 2153 "Tamanyo" => 85505 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Distribution of anterior STEMI patients by month in 2008.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 833 "Ancho" => 1146 "Tamanyo" => 48054 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Distribution of patients by Killip class at admission.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 646 "Ancho" => 1500 "Tamanyo" => 51600 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Distribution of patients according to TIMI risk score for STEMI.</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 826 "Ancho" => 1125 "Tamanyo" => 49860 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Distribution of anterior STEMI patients according to origin. BED/HC: basic emergency departments/health centers; HBA: Hospital Barlavento Algarvio; HF: Emergency Department of Faro Hospital; INEM: Institute for Medical Emergencies.</p>" ] ] 4 => array:7 [ "identificador" => "fig0025" "etiqueta" => "Figure 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr5.jpeg" "Alto" => 812 "Ancho" => 1660 "Tamanyo" => 51245 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Time from diagnostic ECG to balloon angioplasty according to place of first ECG. BED/HC: basic emergency departments/health centers; HBA: Hospital Barlavento Algarvio; HF: Emergency Department of Faro Hospital; INEM: Institute for Medical Emergencies.</p>" ] ] 5 => array:7 [ "identificador" => "fig0030" "etiqueta" => "Figure 6" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr6.jpeg" "Alto" => 771 "Ancho" => 1514 "Tamanyo" => 82079 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Distribution of anterior STEMI patients according to origin (presented as absolute numbers of cases and numbers in which the fast-track system was activated). BED/HC: basic emergency departments/health centers; HBA: Hospital Barlavento Algarvio; HF: Emergency Department of Faro Hospital; INEM: Institute for Medical Emergencies.</p>" ] ] 6 => array:7 [ "identificador" => "fig0035" "etiqueta" => "Figure 7" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr7.jpeg" "Alto" => 625 "Ancho" => 1479 "Tamanyo" => 49418 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Mortality in anterior STEMI patients. 30-d: 30-day mortality; IH CV: in-hospital cardiovascular mortality; IH NCV: in-hospital non-cardiovascular mortality; IH O: overall in-hospital mortality; TIMI: mortality predicted by the TIMI risk score for STEMI. p<0.01: statistical significance comparing observed 30-day mortality and that predicted by the TIMI risk score for STEMI.</p>" ] ] 7 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">CABG: coronary artery bypass grafting; MI: myocardial infarction; PVD: peripheral vascular disease.</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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Personal history \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">No. of patients \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">Hypertension \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">53 \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">Hypercholesterolemia \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">49 \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">Diabetes \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">23 \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">Smoking \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">36 \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">Angina \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">45 \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">MI \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 \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">Coronary angioplasty \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 \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">CABG \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 \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">PVD \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 \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">Stroke \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 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab268611.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Personal clinical histories and cardiovascular risk factors of patients with anterior STEMI.</p>" ] ] 8 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Time interval (min) \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">Median (interquartile range) \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-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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">240 (180–360) \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">Pain-to-diagnosis \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">162 (109–272) \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">Diagnosis-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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">89 (57–108) \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">Door-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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15 (12–20) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab268610.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Time intervals between symptom onset and treatment (presented as medians and interquartile range) of patients with anterior STEMI.</p>" ] ] 9 => array:7 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "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=""><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">Radial access \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">82% \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">Femoral access \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% \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">1-vessel disease \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% \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">2-vessel disease \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">35% \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">3-vessel disease \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">15% \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">Complete revascularization \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">83% \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">Drug-eluting stent \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">81% \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab268608.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Percentages of patients according to type of access, location of coronary lesions, complete revascularization in the initial procedure, and use of drug-eluting stents.</p>" ] ] 10 => array:7 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "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">Yes % \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">No % \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">Female gender \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 \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">2.5 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.57 \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">Cardiogenic shock \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">28.6 \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">1.1 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.01 \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">Cardiopulmonary arrest \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><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">3.3 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.66 \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">Age ≥80 \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">14.3 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.2 \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"><0.01 \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 risk score ≥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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5.6 \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><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">0.10 \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">Killip class ≥2 \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">7.4 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.4 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.12 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab268609.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">Mortality according to risk factors.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:17 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "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: 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. Van de Werf" 1 => "J. Bax" 2 => "A. Betriu" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/eurheartj/ehn416" "Revista" => array:6 [ "tituloSerie" => "Eur Heart J" "fecha" => "2008" "volumen" => "29" "paginaInicial" => "2909" "paginaFinal" => "2945" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19004841" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "ACC/AHA Guidelines for the management of patients with ST-elevation myocardial infarction – executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1999 Guidelines for the Management of Patients With Acute Myocardial Infarction)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "E.M. Antman" 1 => "D.T. Anbe" 2 => "P.W. Armstrong" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/01.CIR.0000134791.68010.FA" "Revista" => array:6 [ "tituloSerie" => "Circulation" "fecha" => "2004" "volumen" => "110" "paginaInicial" => "588" "paginaFinal" => "636" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15289388" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "2007 focused update of the ACC/AHA 2004 guidelines for the management of patients with ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "E.M. Antman" 1 => "M. Hand" 2 => "P.W. Armstrong" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jacc.2007.10.001" "Revista" => array:6 [ "tituloSerie" => "J Am Coll Cardiol" "fecha" => "2008" "volumen" => "51" "paginaInicial" => "210" "paginaFinal" => "247" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18191746" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Determinants and prognostic impact of heart failure complicating acute coronary syndromes: observations from the Global Registry of Acute Coronary Syndromes (GRACE)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "P.G. Steg" 1 => "O.H. Dablou" 2 => "L.J. Feldman" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/01.CIR.0000109691.16944.DA" "Revista" => array:6 [ "tituloSerie" => "Circulation" "fecha" => "2004" "volumen" => "109" "paginaInicial" => "494" "paginaFinal" => "499" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14744970" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Predictors of hospital mortality in the Global Registry of Acute Coronary Events" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "C.B. Granger" 1 => "R.J. Goldberg" 2 => "O. Dolboun" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/archinte.163.19.2345" "Revista" => array:5 [ "tituloSerie" => "Arch Intern Med" "fecha" => "2003" "volumen" => "163" "paginaInicial" => "2345" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14581255" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The impact of circadian variation on outcomes in emergency acute anterior myocardial infarction percutaneous coronary intervention" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "A.R. Assali" 1 => "D. Brosh" 2 => "H. Vaknin-Assa" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/ccd.20608" "Revista" => array:6 [ "tituloSerie" => "Catheter Cardiovasc Interv" "fecha" => "2006" "volumen" => "67" "paginaInicial" => "221" "paginaFinal" => "226" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16404750" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "An overview of the patency and stroke rates following thrombolysis with streptokinase, alteplase and anistreplase used to treat an acute myocardial infarction" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "C.S. Baxter-Jones" 1 => "H.D. White" 2 => "J.L. Anderson" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Interv Cardiol" "fecha" => "2007" "volumen" => "6" "paginaInicial" => "15" "paginaFinal" => "23" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10171637" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prospective evaluation of eligibility for thrombolytic therapy in acute myocardial infarction" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "J.K. Frenche" 1 => "B.F. Williams" 2 => "H.H. Horte" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "BMJ" "fecha" => "1996" "volumen" => "312" "paginaInicial" => "1637" "paginaFinal" => "1641" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8664716" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalence of normal coronary angiography in the acute phase of suspected ST elevation myocardial infarction: experience from the Prague studies" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "P. Widimsky" 1 => "B. Stelbova" 2 => "L. Groch" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Can J Cardiol" "fecha" => "2006" "volumen" => "22" "paginaInicial" => "1147" "paginaFinal" => "1152" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17102833" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Implementation of guidelines for the treatment of acute ST-elevation myocardial infarction: the Cologne infarction model registry" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "M. Flesch" 1 => "J. Hagemeister" 2 => "H.J. Berger" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/CIRCINTERVENTIONS.108.768176" "Revista" => array:6 [ "tituloSerie" => "Circ Cardiovasc Interv" "fecha" => "2008" "volumen" => "1" "paginaInicial" => "95" "paginaFinal" => "102" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20031663" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0055" "etiqueta" => "11" "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" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0060" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Feasibility and efficacy of transradial access for coronary interventions in patients with acute myocardial infarction" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "S.R. Mulukutla" 1 => "H.A. Cohen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/ccd.10300" "Revista" => array:6 [ "tituloSerie" => "Catheter Cardiovasc Interv" "fecha" => "2002" "volumen" => "57" "paginaInicial" => "167" "paginaFinal" => "171" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12357514" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0065" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Comparison of the predictive value of four different risk scores for outcomes of patients with ST-elevation acute myocardial infarction undergoing primary percutaneous coronary intervention" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "E.I. Lev" 1 => "R. Kornowski" 2 => "H. Vaknin-Assa" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.amjcard.2008.02.088" "Revista" => array:6 [ "tituloSerie" => "Am J Cardiol" "fecha" => "2008" "volumen" => "102" "paginaInicial" => "6" "paginaFinal" => "11" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18572028" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0070" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Five-year experience with transradial coronary angioplasty in ST-segment elevation myocardial infarction" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "Z. Ruzsa" 1 => "I. Ungi" 2 => "T. Horváth" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.carrev.2008.07.004" "Revista" => array:6 [ "tituloSerie" => "Cardiovasc Revasc Med" "fecha" => "2009" "volumen" => "10" "paginaInicial" => "73" "paginaFinal" => "79" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19327668" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0075" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Reduced vascular complications and length of stay with transradial rescue angioplasty for acute myocardial infarction" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "N.L. Cruden" 1 => "C.H. Teh" 2 => "I.R. Starkey" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/ccd.21182" "Revista" => array:6 [ "tituloSerie" => "Catheter Cardiovasc Interv" "fecha" => "2007" "volumen" => "70" "paginaInicial" => "670" "paginaFinal" => "675" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17563094" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0080" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Single or multivessel percutaneous coronary intervention in ST-elevation myocardial infarction patients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "E. Varani" 1 => "M. Balducelli" 2 => "M. Aquilina" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/ccd.21722" "Revista" => array:6 [ "tituloSerie" => "Catheter Cardiovasc Interv" "fecha" => "2008" "volumen" => "72" "paginaInicial" => "927" "paginaFinal" => "933" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18798239" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0085" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Drug-eluting or bare-metal stents for acute myocardial infarction" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "L. Mauri" 1 => "T.S. Silbaugh" 2 => "P. Garg" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMoa0801485" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2008" "volumen" => "359" "paginaInicial" => "1330" "paginaFinal" => "1342" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18815397" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21742049/0000003100000010/v1_201305151709/S2174204912001407/v1_201305151709/en/main.assets" "Apartado" => array:4 [ "identificador" => "9917" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original Articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21742049/0000003100000010/v1_201305151709/S2174204912001407/v1_201305151709/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204912001407?idApp=UINPBA00004E" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 7 | 6 | 13 |
| 2024 October | 40 | 25 | 65 |
| 2024 September | 38 | 20 | 58 |
| 2024 August | 43 | 28 | 71 |
| 2024 July | 33 | 32 | 65 |
| 2024 June | 35 | 20 | 55 |
| 2024 May | 41 | 24 | 65 |
| 2024 April | 26 | 19 | 45 |
| 2024 March | 35 | 19 | 54 |
| 2024 February | 42 | 19 | 61 |
| 2024 January | 32 | 23 | 55 |
| 2023 December | 31 | 30 | 61 |
| 2023 November | 29 | 22 | 51 |
| 2023 October | 27 | 14 | 41 |
| 2023 September | 30 | 22 | 52 |
| 2023 August | 18 | 10 | 28 |
| 2023 July | 23 | 13 | 36 |
| 2023 June | 30 | 13 | 43 |
| 2023 May | 29 | 28 | 57 |
| 2023 April | 34 | 5 | 39 |
| 2023 March | 33 | 17 | 50 |
| 2023 February | 21 | 26 | 47 |
| 2023 January | 18 | 15 | 33 |
| 2022 December | 40 | 26 | 66 |
| 2022 November | 46 | 31 | 77 |
| 2022 October | 34 | 12 | 46 |
| 2022 September | 26 | 37 | 63 |
| 2022 August | 34 | 26 | 60 |
| 2022 July | 30 | 33 | 63 |
| 2022 June | 21 | 26 | 47 |
| 2022 May | 24 | 37 | 61 |
| 2022 April | 26 | 23 | 49 |
| 2022 March | 29 | 36 | 65 |
| 2022 February | 20 | 25 | 45 |
| 2022 January | 30 | 18 | 48 |
| 2021 December | 24 | 29 | 53 |
| 2021 November | 29 | 36 | 65 |
| 2021 October | 38 | 43 | 81 |
| 2021 September | 25 | 16 | 41 |
| 2021 August | 26 | 25 | 51 |
| 2021 July | 22 | 25 | 47 |
| 2021 June | 15 | 25 | 40 |
| 2021 May | 28 | 44 | 72 |
| 2021 April | 47 | 31 | 78 |
| 2021 March | 56 | 18 | 74 |
| 2021 February | 34 | 23 | 57 |
| 2021 January | 18 | 8 | 26 |
| 2020 December | 27 | 5 | 32 |
| 2020 November | 34 | 20 | 54 |
| 2020 October | 19 | 9 | 28 |
| 2020 September | 60 | 8 | 68 |
| 2020 August | 17 | 11 | 28 |
| 2020 July | 39 | 11 | 50 |
| 2020 June | 30 | 5 | 35 |
| 2020 May | 33 | 7 | 40 |
| 2020 April | 31 | 6 | 37 |
| 2020 March | 47 | 11 | 58 |
| 2020 February | 60 | 13 | 73 |
| 2020 January | 30 | 8 | 38 |
| 2019 December | 40 | 6 | 46 |
| 2019 November | 15 | 7 | 22 |
| 2019 October | 33 | 7 | 40 |
| 2019 September | 20 | 9 | 29 |
| 2019 August | 25 | 7 | 32 |
| 2019 July | 43 | 11 | 54 |
| 2019 June | 26 | 8 | 34 |
| 2019 May | 29 | 10 | 39 |
| 2019 April | 22 | 17 | 39 |
| 2019 March | 33 | 9 | 42 |
| 2019 February | 86 | 8 | 94 |
| 2019 January | 51 | 2 | 53 |
| 2018 December | 82 | 7 | 89 |
| 2018 November | 174 | 5 | 179 |
| 2018 October | 322 | 12 | 334 |
| 2018 September | 66 | 13 | 79 |
| 2018 August | 63 | 11 | 74 |
| 2018 July | 39 | 5 | 44 |
| 2018 June | 38 | 8 | 46 |
| 2018 May | 47 | 9 | 56 |
| 2018 April | 35 | 3 | 38 |
| 2018 March | 48 | 7 | 55 |
| 2018 February | 32 | 9 | 41 |
| 2018 January | 33 | 4 | 37 |
| 2017 December | 64 | 4 | 68 |
| 2017 November | 41 | 7 | 48 |
| 2017 October | 45 | 8 | 53 |
| 2017 September | 42 | 14 | 56 |
| 2017 August | 50 | 10 | 60 |
| 2017 July | 43 | 10 | 53 |
| 2017 June | 44 | 11 | 55 |
| 2017 May | 56 | 7 | 63 |
| 2017 April | 74 | 2 | 76 |
| 2017 March | 41 | 13 | 54 |
| 2017 February | 31 | 6 | 37 |
| 2017 January | 38 | 4 | 42 |
| 2016 December | 43 | 15 | 58 |
| 2016 November | 39 | 3 | 42 |
| 2016 October | 36 | 8 | 44 |
| 2016 September | 23 | 9 | 32 |
| 2016 August | 5 | 2 | 7 |
| 2016 July | 12 | 2 | 14 |
| 2016 June | 3 | 3 | 6 |
| 2016 May | 11 | 4 | 15 |
| 2016 April | 23 | 1 | 24 |
| 2016 March | 50 | 11 | 61 |
| 2016 February | 64 | 19 | 83 |
| 2016 January | 42 | 13 | 55 |
| 2015 December | 51 | 9 | 60 |
| 2015 November | 49 | 13 | 62 |
| 2015 October | 44 | 12 | 56 |
| 2015 September | 49 | 7 | 56 |
| 2015 August | 35 | 12 | 47 |
| 2015 July | 29 | 8 | 37 |
| 2015 June | 24 | 3 | 27 |
| 2015 May | 25 | 6 | 31 |
| 2015 April | 41 | 14 | 55 |
| 2015 March | 32 | 12 | 44 |
| 2015 February | 38 | 16 | 54 |
| 2015 January | 35 | 4 | 39 |
| 2014 December | 41 | 12 | 53 |
| 2014 November | 29 | 4 | 33 |
| 2014 October | 50 | 11 | 61 |
| 2014 September | 50 | 8 | 58 |
| 2014 August | 29 | 9 | 38 |
| 2014 July | 43 | 10 | 53 |
| 2014 June | 32 | 8 | 40 |
| 2014 May | 36 | 7 | 43 |
| 2014 April | 35 | 6 | 41 |
| 2014 March | 56 | 17 | 73 |
| 2014 February | 56 | 11 | 67 |
| 2014 January | 61 | 18 | 79 |
| 2013 December | 63 | 16 | 79 |
| 2013 November | 66 | 16 | 82 |
| 2013 October | 55 | 12 | 67 |
| 2013 September | 62 | 15 | 77 |
| 2013 August | 72 | 15 | 87 |
| 2013 July | 75 | 23 | 98 |
| 2013 June | 73 | 11 | 84 |
| 2013 May | 65 | 18 | 83 |
| 2013 April | 95 | 23 | 118 |
| 2013 March | 75 | 16 | 91 |
| 2013 February | 66 | 21 | 87 |
| 2013 January | 86 | 31 | 117 |
| 2012 December | 53 | 19 | 72 |
| 2012 November | 45 | 25 | 70 |
| 2012 October | 52 | 27 | 79 |
Show all
