Impact of creating a haemodynamics room, a coronary unit and a primary angioplasty programme on the prognosis of acute coronary syndrome in a district hospital

M N Solís-Marquínez; J J Rondán-Murillo; M Pérez-Otero; J M Vegas-Valle; Í Lozano Martínez-Luengas; J Morís-de la Tassa

doi:10.1016/j.rce.2019.11.015

Impact of creating a haemodynamics room, a coronary unit and a primary angioplasty programme on the prognosis of acute coronary syndrome in a district hospital

Rev Clin Esp. 2021 Apr;221(4):187-197. doi: 10.1016/j.rce.2019.11.015. Epub 2020 Feb 26.

[Article in English, Spanish]

Authors

M N Solís-Marquínez¹, J J Rondán-Murillo², M Pérez-Otero³, J M Vegas-Valle², Í Lozano Martínez-Luengas², J Morís-de la Tassa⁴

Affiliations

¹ Servicio de Medicina Interna, Hospital Universitario de Cabueñes, Gijón, España. Electronic address: natayasolis@gmail.com.
² Servicio de Cardiología, Hospital Universitario de Cabueñes, Gijón, España.
³ Servicio de Urgencias, Hospital Universitario Central de Asturias, Oviedo, España.
⁴ Servicio de Medicina Interna, Hospital Universitario de Cabueñes, Gijón, España; Facultad de Medicina y Ciencias de la Salud, Universidad de Oviedo, Oviedo, España.

PMID: 32113647
DOI: 10.1016/j.rce.2019.11.015

Abstract

Objective: This work aims to analyze the prognosis and mortality of patients hospitalized for acute coronary syndrome before and after the implementation of a coronary care unit, hemodynamics room, and the Código Corazón [Infarction Code] primary angioplasty program METHODS: We conducted an observational, retrospective study that analyzed the epidemiological characteristics, reperfusion strategies, adverse cardiovascular events, and mortality over a follow-up period of five years. The results from the post-code period (March 1 - December 31, 2012; n=471) were compared with those from the pre-code period (March 1 - December 31, 2009; n=432).

Results: There were no differences in the baseline characteristics of the two groups. However, an increase in ST-elevation acute coronary syndrome (STE-ACS) from 17.6% to 34.8% (p<.001) was observed during the postcode phase. The use of percutaneous coronary intervention was made widespread at the hospital and was used in 64.8% of non-ST-elevation acute coronary syndrome (NSTE-ACS) cases and in 95.5% of STE-ACS cases. A reduction was observed in readmissions (from 38.2% to 25.1% for NSTE-ACS (p=.001) and from 23.7% to 11.0% for STE-ACS (p=.018)), the composite prognostic variable of adverse cardiovascular events and 5-year mortality (from 58.7% to 45% (p=.001) for NSTE-ACS and from 40.8% to 23.8% (p=.009) for STE-ACS), and a decrease in 30-day mortality in STE-ACS (from 11.8% to 3.7%; p=.021).

Conclusions: With the structural changes in the hospital, the use of percutaneous coronary intervention was made widespread and improved the prognosis of patients with acute coronary syndrome, decreasing admissions, adverse cardiovascular events and mortality.

Keywords: Acute myocardial infarction; Código infarto; Infarction code; Infarto agudo de miocardio; Intervencionismo coronario percutáneo; Mortalidad; Mortality; Non-ST-elevation acute coronary syndrome; Percutaneous coronary intervention; ST-elevation acute coronary syndrome; Síndrome coronario agudo con elevación del ST; Síndrome coronario agudo sin elevación del ST.