Authors (including presenting author) :
Wong CY(1), Lam H(2), Mok WY(2), Chan WY(2), Yiu KY(2), Lai YF(2), Lee KY(2), So F L(1), Lai LP(2), Yam PW(2), Lau CL(1)
Affiliation :
(1) Accident and Emergency Department, Tin Shui Wai Hospital (2) Department of Medicine and Geriatrics, Tuen Mun Hospital
Introduction :
Tin Shui Wai Hospital (TSWH) Accident and Emergency Department (AED) has implemented Time-Mediated Hybrid Reperfusion Service Model for ST-Elevation Myocardial Infarction (STEMI); in collaboration with Department of Medicine and Geriatrics, Tuen Mun Hospital (TMH) since 2017.
During Primary Percutaneous Coronary Intervention (PPCI) service hours (8am to 8 pm on weekdays), STEMI patients arengiven loading doses of aspirin, ticagrelor and intravenous heparin if anticipated diagnosis-to-wire time is within 90 mins. Patients are then immediately escorted by doctor to TMH catheterization laboratory for PPCI. Unstable patients are optimized with airway, ventilation and hemodynamic support before transfer.
When anticipated diagnosis-to-wire time is beyond 90 minutes, Pharmacoinvasive-PCI approach is adopted. Aspirin, clopidogrel, intravenous enoxaparin and fibrinolysis by tenecteplase (TNK) are given in TSWH AED. Patients are then escorted by doctor to TMH. PCI will be performed within 2 to 24 hours if patient was stable. In case of unstable hemodynamics or failed fibrinolysis, rescue PCI is performed within 120mins. Patients with contraindications for TNK are transferred to TMH for Primary PCI.
Objectives :
This study aims to evaluate the coverage, diagnosis-to-wire time and 30-day PCI mortality under Time-Mediated Hybrid Reperfusion model for Transfer-PCI service.
Methodology :
All STEMI patients undergoing PCI from April 2017 to December 2019 were included. The Diagnosis-to-Wire time, en-route adverse events and 30-day mortality were analyzed. The exclusion criterion was pre-hospital cardiac arrest.
Result & Outcome :
There were 85 STEMI cases. 16% were hemodynamically unstable. There were no major en-route adverse events. The PCI coverage was 80%. 27 patients received PPCI. 36 patients received PCI after TNK and 5 patients received rescue PCI. The ESC STEMI Guideline recommended the Diagnosis-to-Wire (DTW) time in transported patients for PPCI to be within 90 minutes. 93% patients achieved target DTW time in PPCI stream. The PCI 30-day mortality was zero. The average reperfusion therapy rate in Europe (Spain, Italy and France etc.) was 81.2%. Our PCI coverage was up to 80%; which was comparable to European countries. Transfer-PCI has an important role in the STEMI management in Hong Kong. The PCI coverage was 80% and 30-day PCI mortality was zero. The system efficiency was well demonstrated by short Diagnosis-to-Wire time.
