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corresponding to all patients with STEMI who underwent coronary angiography at the participating centers for a one-month period every year from 2011 to 2015&#46; Patient data were collected from the National Registry of Interventional Cardiology &#40;RNCI&#41; and the Portuguese Registry of Acute Coronary Syndromes &#40;ProACS&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">3&#44;4</span></a> It is somewhat regrettable that only the data for a single month per year were used when the information for the whole year was also available in these continuous registries&#46; This was in fact considered a limitation of the study by the authors&#46; In the last year of the study period&#44; patients were older and had a higher prevalence of diabetes&#44; and more patients were admitted to a hospital with percutaneous coronary intervention &#40;PCI&#41; facilities through the emergency medical services &#40;EMS&#41;&#44; compared to previous years&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The aim of the study was to analyze system delay&#44; defined as the time between first medical contact and reperfusion therapy&#44; as an indicator of the quality of primary PCI in STEMI&#46; Despite all the campaigns in the medical media&#44; in meetings and in congresses based on the Stent for Life initiative&#44; no significant changes were observed in system delay during the study period&#46; After a thorough analysis of all possible predictive factors&#44; only three predicted longer system delay on multivariate analysis&#58; age &#8805;75 years&#44; admission to a hospital without PCI&#44; and residence in the Central region of Portugal&#46; The only positive predictive factor for shorter system delay was calling the national medical emergency number &#40;112&#41;&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Several important conclusions can be drawn from these findings&#46; First&#44; the Stent for Life initiative did not fully reach the patients who should be the main beneficiaries of better health system organization&#46; This is a well-known problem in many countries&#46; Patients do not know the symptoms of myocardial infarction &#40;MI&#41; or do not recognize them early enough&#46; This is particularly true in elderly patients&#46; It requires the government&#44; specifically the Ministry of Health&#44; to promote comprehensive public education campaigns to improve awareness of alarm symptoms&#46; Age should not be a contraindication&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">In parallel with such campaigns&#44; the government should educate the population that in the event of suspected MI&#44; the correct response is to call 112&#46; This has been improving in Portugal but the system does not cover all areas of the country equally&#46; For example&#44; the Central region is a largely rural area in which long distances have to be traveled to a well-equipped hospital with PCI facilities&#46; It is interesting that in the current study&#44; using univariate analysis&#44; arrival of patients at a PCI center by their own means of transport was associated with shorter system delay&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">But the study&#39;s conclusions are strong enough to compel the government to take responsibility for reducing mortality in patients with MI&#46; The population should be informed and educated to improve their awareness of the symptoms of MI and the best way to reach a suitable hospital through the EMS&#46; 112 should be the emergency number to use throughout the country&#46; The Central region of Portugal should be better equipped with facilities for primary PCI as part of national coverage for better treatment of MI&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0040" class="elsevierStylePara elsevierViewall">The author has no conflicts of interest to declare&#46;</p></span></span>"
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Toward a better knowledge of how to improve patient care in ST-elevation myocardial infarction
Rumo a um melhor conhecimento sobre como melhorar os cuidados ao doente com enfarte do miocário com elevação do segment-ST
R. Seabra Gomes
Instituto do Coração, Carnaxide, Portugal
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The paper by Pereira et al&#46; in this issue of the <span class="elsevierStyleItalic">Journal</span><a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a> represents an excellent and unique analysis of the treatment of ST-elevation myocardial infarction &#40;STEMI&#41; in Portugal that may also be useful to other European countries&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The authors analyze changes in the treatment of STEMI patients since Portugal joined the &#8216;Stent for Life&#8217; initiative developed by the European Association of Percutaneous Cardiovascular Interventions and the European Society of Cardiology&#44; which aimed to improve treatment of STEMI&#44; reduce related mortality and increase the number of patients treated&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The study included 838 patients admitted to 18 hospitals&#44; corresponding to all patients with STEMI who underwent coronary angiography at the participating centers for a one-month period every year from 2011 to 2015&#46; Patient data were collected from the National Registry of Interventional Cardiology &#40;RNCI&#41; and the Portuguese Registry of Acute Coronary Syndromes &#40;ProACS&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">3&#44;4</span></a> It is somewhat regrettable that only the data for a single month per year were used when the information for the whole year was also available in these continuous registries&#46; This was in fact considered a limitation of the study by the authors&#46; In the last year of the study period&#44; patients were older and had a higher prevalence of diabetes&#44; and more patients were admitted to a hospital with percutaneous coronary intervention &#40;PCI&#41; facilities through the emergency medical services &#40;EMS&#41;&#44; compared to previous years&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The aim of the study was to analyze system delay&#44; defined as the time between first medical contact and reperfusion therapy&#44; as an indicator of the quality of primary PCI in STEMI&#46; Despite all the campaigns in the medical media&#44; in meetings and in congresses based on the Stent for Life initiative&#44; no significant changes were observed in system delay during the study period&#46; After a thorough analysis of all possible predictive factors&#44; only three predicted longer system delay on multivariate analysis&#58; age &#8805;75 years&#44; admission to a hospital without PCI&#44; and residence in the Central region of Portugal&#46; The only positive predictive factor for shorter system delay was calling the national medical emergency number &#40;112&#41;&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Several important conclusions can be drawn from these findings&#46; First&#44; the Stent for Life initiative did not fully reach the patients who should be the main beneficiaries of better health system organization&#46; This is a well-known problem in many countries&#46; Patients do not know the symptoms of myocardial infarction &#40;MI&#41; or do not recognize them early enough&#46; This is particularly true in elderly patients&#46; It requires the government&#44; specifically the Ministry of Health&#44; to promote comprehensive public education campaigns to improve awareness of alarm symptoms&#46; Age should not be a contraindication&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">In parallel with such campaigns&#44; the government should educate the population that in the event of suspected MI&#44; the correct response is to call 112&#46; This has been improving in Portugal but the system does not cover all areas of the country equally&#46; For example&#44; the Central region is a largely rural area in which long distances have to be traveled to a well-equipped hospital with PCI facilities&#46; It is interesting that in the current study&#44; using univariate analysis&#44; arrival of patients at a PCI center by their own means of transport was associated with shorter system delay&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">But the study&#39;s conclusions are strong enough to compel the government to take responsibility for reducing mortality in patients with MI&#46; The population should be informed and educated to improve their awareness of the symptoms of MI and the best way to reach a suitable hospital through the EMS&#46; 112 should be the emergency number to use throughout the country&#46; The Central region of Portugal should be better equipped with facilities for primary PCI as part of national coverage for better treatment of MI&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0040" class="elsevierStylePara elsevierViewall">The author has no conflicts of interest to declare&#46;</p></span></span>"
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Article information
ISSN: 21742049
Original language: English
DOI:10.1016/j.repce.2018.08.002
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