Türkiyede Primer Perkütan Koroner Girişim Yapılamayan Merkezlerde Akut ST-Segment Elevasyonlu Miyokart İnfarktüsünün Erken Tanısı Üzerine Akıllı Telefon Teknolojisinin Etkisi

Yıl 2016, Cilt: 19 Sayı: 3, 143 - 148, 01.12.2016

Kahraman Coşansu Hüseyin Altuğ Çakmak , Erkan Yıldırım

Öz

Giriş: Bu makalenin amacı akıllı telefon kullanılan dönemde çalışma ve çalışma
dışı saatleri (ÇDS)’nde akut ST-elevasyonlu miyokart infarktüsü (STEMİ)’nün
ortalama tanı süresini belirlemektir. Ayrıca uygulama varlığı ve yokluğunda
ÇDS’deki tanı zamanları arasında önemli farklılık olup olmadığına bakılacaktır.

Hastalar ve
Yöntem: Bu retrospektif çalışmaya Ocak 2013-Nisan 2014
tarihlerinde STEMİ tanısı konup primer perkütan koroner girişim (PKG) için
transfer edilen 174 hasta alındı. Bu periyotta, hastanede ÇDS’de akıllı telefon
kullanılmaktaydı. Ayrıca Ocak 2012-Kasım 2012 tarihlerinde ÇDS’de kardiyoloğun
acile çağırılması veya hastane bilgisayarından kardiyoloğa elektronik posta ile
elektrokardiyografi gönderilmesi yoluyla STEMİ tanısı konan 58 hasta alındı.

Bulgular: Uygulamanın kullanılmaya başlanılması sonrası çalışma sırasında hastaların
tanı süresi ortalama 7.9 ± 1.7 dakikaydı. ÇDS’de STEMİ tanısı ortalama 8.2 ±
1.4 dakika olarak saptandı. Çalışma ve ÇDS arasında tanı zamanlarında fark
görülmedi (p= 0.143). Uygulamanın kullanılmaya başlanması öncesi ÇDS’de STEMİ
tanı süresi 18.0 ± 3.1 dakikaydı. ÇDS’de uygulama başlangıcı öncesi ve sonrası
arasında STEMİ tanı süresi açısından anlamlı fark saptandı (p< 0.001).

Sonuç: Akıllı telefon
uygulamalarının özellikle PKG yapılamayan merkezlerde ÇDS’de kullanılması STEMİ
tedavisindeki gecikmeyi azaltarak kısa ve uzun dönem klinik sonuçlarda iyileşme
sağlayabilir.

Anahtar Kelimeler

ST-elevasyonlu miyokart infarktüsü, elektrokardiyografi, akıllı telefon uygulaması, perkütan koroner girişim

Impact of Smartphone Technology on the Early Diagnosis of Acute ST-Segment Elevation Myocardial Infarction at Non-Primary Percutaneous Coronary Intervention Capable Centres in Turkey

Öz

Introduction:
This
study aimed to determine the mean time for diagnosis of acute ST-segment
elevation myocardial infarction (STEMI) for both working hours (WHs) and
non-WHs (NWHs) during the period that a smartphone application was in use to
aid the speed of diagnosis and any significant difference in diagnosis times
during NWHs with and without use of the application.

Patients
and Methods: In this retrospective study, 174 patients who had been
diagnosed with STEMI and transferred for primary percutaneous coronary
intervention between January 2013 and April 2014 were recruited. During this
period, the hospital used a smartphone application to aid diagnosis during
NWHs. In addition, 58 patients who were diagnosed with STEMI during NWHs
between January 2012 and November 2012, either by a cardiologist called to the
emergency department or an electrocardiography being sent to the cardiologist’s
e-mail from a hospital computer, were enrolled.

Results: After the
smartphone application was used, patients were diagnosed in a mean time of 7.9
± 1.7 min during WHs, whereas STEMI was diagnosed in a mean time of 8.2 ± 1.4
min during NWHs. There was no statistically significant difference in diagnosis
times between WHs and NWHs (p= 0.143). However, before the application was
used, the mean time for the diagnosis of STEMI was 18.0 ± 3.1 min during NWHs,
and consequently, there was a significant difference in STEMI diagnosis times
during NWHs before and after the application began to be used (p< 0.001).

Conclusion: The application of
smartphones, especially during NWHs at non-percutaneous coronary
intervention-capable centres, can significantly reduce delays in STEMI
treatment, which can result in improved short- and long-term clinical outcomes.

Anahtar Kelimeler

ST elevation myocardial infarction, electrocardiography, smartphone application, percutaneous coronary intervention

Kaynakça

• 1. WHO Factsheet N8310, updated June 2011. Available from: http://www.who.int/mediacentre/factsheets/fs310/en/index.html.
• 2. Torres M, Moayedi S. “Evaluation of theacutely dyspneic elderly patient”. Clin Geriatr Med 2007;23:307-25.
• 3. Luepker RV, Raczynski JM, Osganian S, Goldberg RJ, Finnegan JR Jr, Hedges JR, et al. Effect of a community intervention on patientdelay and emergency medical service use in acute coronary heart disease: The Rapid Early Action for Coronary Treatment (REACT) Trial. JAMA 2010;304:763-71.
• 4. Steg PG, Bonnefoy E, Chabaud S, Lapostolle F, Dubien PY, CristoÞni P, et al. Impact of time to treatment on mortality after prehospital Þbrinolysis or primary angioplasty: data from the CAPTIM randomized clinical trial. Circulation 2003;108:2851-7.
• 5. Pinto DS, Kirtane AJ, Nallamothu BK, Murphy SA, Cohen DJ, Laham RJ, et al. Hospital delays in reperfusion for ST-elevation myocardial infarction: implications when selecting a reperfusion strategy. Circulation 2006;114:2019-25.
• 6. Boersma E. Does time matter? A pooled analysis of randomized clinical trials comparing primary percutaneus coronary intervention and in-hospital fibrinolysis in acute miyocardial infarction patients. Eur Heart J 2006;27:779-88.
• 7. Thygesen K, Alpert JS, White HD. Universal deÞnition of myocardial infarction. Eur Heart J 2007;28:2525-38.
• 8. Thygesen K, Alpert JS, Jaffe AS, Simoons ML, Chaitman BR, White HD. Third universal definition of myocardial infarction. Circulation 2012;126:2020-35.
• 9. Go AS, Barron HV, Rundle AC, Ornato JP, Avins AL. National Registry of Myocardial Infarction 2 Investigators Bundle-branch block and in-hospital mortality in acute myocardial infarction. Ann Intern Med 1998;129:690-7.
• 10. Yeh RW, Sidney S, Chandra M, Sorel M, Selby JV, Go AS. Population trends in the incidence and outcomes of acute myocardial infarction. N Engl J Med 2010;362:2155-65.
• 11. Goldberg RJ, Spencer FA, Fox KA, Brieger D, Steg PG, Gurfinkel E, et al. Prehospital delay in patients with acute coronary syndromes (from the Global Registry of Acute Coronary Events [GRACE]). Am J Cardiol 2009;103:598-603.
• 12. Spencer FA, Montalescot G, Fox KA, Goodman SG, Granger CB, Goldberg RJ. Delay to reperfusion in patientswith acute myocardial infarction presenting to acute care hospitals: an international perspective. Eur Heart J 2010;31:1328-36.
• 13. Finnegan JR Jr, Meischke H, Zapka JG, Leviton L, Meshack A, Benjamin-Garner R, et al. Patient delay in seeking care for heart attack symptoms: findings from focus groups conducted in five U.S. regions. Prev Med 2000;31:205-13.
• 14. 2013 ACCP/AHA Guideline for the management of ST-Elevation myocardial Infarction.
• 15. Mathews R, Peterson ED, Li S, Roe MT, Glickman SW, Wiviott SD, et al. Use of emergency medical service transport among patients with ST-segment-elevation myocardial infarction: findings from the National Cardiovascular Data Registry Acute Coronary Treatment Intervention Outcomes Network Registry-Get With The Guidelines. Circulation 2011;124:154-63.
• 16. Sørensen JT, Terkelsen CJ, Nørgaard BL, Trautner S, Hansen TM, Bøtker HE, et al. Urban and rural implementation of pre-hospital diagnosis and direct referral for primary percutaneous coronary intervention in patients with acute ST-elevation myocardial infarction. Eur Heart J 2011;32:430-6.
• 17. Le May MR, So DY, Dionne R, Glover CA, Froeschl MP, Wells GA, et al. A city wide protocol for primary PCI in ST-segment elevation myocardial infarction. N Engl J Med 2008;358:231-40.
• 18. Rokos IC, French WJ, Koenig WJ, Stratton SJ, Nighswonger B, Strunk B, et al. Integration of pre-hospital electrocardiograms and ST-elevation myocardial infarction receiving center (SRC) networks: impact on door-to-balloon times a cross 10 independent regions. JACC Cardiovasc Interv 2009;2:339-46.
• 19. Fibrinolytic Therapy Trialists’ (FTT) Collaborative Group. Indications for fibrinolytic therapy in suspected acute myocardia linfarction: collaborative overview of early mortality and major morbidity results from all randomised trials of more than 1000 patients. Lancet 1994;343:311-22.
• 20. Keeley EC, Boura JA, Grines CL. Primary angioplasty versus intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review of 23 randomised trials. Lancet 2003;361:13-20.
• 21. Andersen HR, Nielsen TT, Vesterlund T, Grande P, Abildgaard U, Thayssen P, et al. Danish multicenter randomized study on fibrinolytic therapy versus acute coronary angioplasty in acute myocardial infarction: rationale and design of the DANish trial in Acute Myocardial Infarction-2 (DANAMI-2). Am Heart J 2003;146:234-41.
• 22. Dalby M, Bouzamondo A, Lechat P, Montalescot G. Transfer for primary angioplasty versus immediate thrombolysis in acute myocardial infarction: a meta-analysis. Circulation 2003;108:1809-14.
• 23. Andersen HR, Nielsen TT, Rasmussen K, Thuesen L, Kelbaek H, Thayssen P, et al. DANAMI-2 Investigators. A comparison of coronary angioplasty with fibrinolytic therapy in acute myocardial infarction. N Engl J Med 2003;349:733-42.
• 24. Nielsen PH, Terkelsen CJ, Nielsen TT, Thuesen L, Krusell LR, Thayssen P, et al. Danami-2 Investigators. System delay and timing of intervention in acute myocardial infarction (from the Danish Acute Myocardial Infarction-2 [DANAMI-2] trial). Am J Cardiol 2011;108:776-81.
• 25. Nallamothu BK, Bates ER. Percutaneous coronary intervention versus fibrinolytic therapy in acute myocardial infarction: is timing (almost) everything? Am J Cardiol 2003;92:824-6.
• 26. Pinto DS, Kirtane AJ, Nallamothu BK, Murphy SA, Cohen DJ, Laham RJ, et al. Hospital delays in reperfusion for ST-elevation myocardial infarction: implications when selecting a reperfusion strategy. Circulation 2006;114:2019-25.
• 27. Rathore SS, Curtis JP, Chen J, Wang Y, Nallamothu BK, Epstein AJ, et al. National Cardiovascular Data Registry. Association of door-to-balloon time and mortality in patients admitted to hospital with ST elevation myocardial infarction: national cohort study. BMJ 2009;338:b1807.
• 28. Terkelsen CJ, Jensen LO, Tilsted HH, Trautner S, Johnsen SP, Vach W, et al. Health care system delay and heart failure in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention: follow-up of population-based medical registry data. Ann Intern Med 2011;155:361-7.
• 29. De Luca G, Suryapranata H, Ottervanger JP, Antman EM. Time delay to treatment and mortality in primary angioplasty for acute myocardial infarction: every minute of delay counts. Circulation 2004;109:1223-5.
• 30. Terkelsen CJ, Sørensen JT, Maeng M, Jensen LO, Tilsted HH, Trautner S, et al. System delay and mortality among patients with STEMI treated with primary percutaneous coronary intervention. JAMA 2010;304:763-71.
• 31. Widimský P, Budesínský T, Vorác D, Groch L, Zelízko M, Aschermann M, et al. ‘PRAGUE’ Study Group Investigators. Long distance transport for primary angioplasty vsim mediate thrombolysis in acute myocardial infarction. Final results of the randomized national multicentre trial--PRAGUE-2. Eur Heart J 2003;24:94-104.
• 32. Wang TY, Nallamothu BK, Krumholz HM, Li S, Roe MT, Jollis JG, et al. Association of door-in to door-out time with reperfusion delays and outcomes among patients transferred for primary percutaneous coronary intervention. JAMA 2011;305:2540-7.