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Vol. 221. Issue 4.
Pages 187-197 (April 2021)
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Vol. 221. Issue 4.
Pages 187-197 (April 2021)
Original article
Impact of creating a hemodynamics room, a coronary care unit, and a primary angioplasty program on the prognosis of acute coronary syndrome in a district hospital
Impacto de la creación de una sala de hemodinámica, una unidad coronaria y un programa de angioplastia primaria en el pronóstico del síndrome coronario agudo en un hospital comarcal
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M.N. Solís-Marquíneza,
Corresponding author
natayasolis@gmail.com

Corresponding author.
, J.J. Rondán-Murillob, M. Pérez-Oteroc, J.M. Vegas-Valleb, Í. Lozano Martínez-Luengasb, J. Morís-de la Tassaa,d
a Servicio de Medicina Interna, Hospital Universitario de Cabueñes, Gijón, Spain
b Servicio de Cardiología, Hospital Universitario de Cabueñes, Gijón, Spain
c Servicio de Urgencias. Hospital Universitario Central de Asturias, Oviedo, Spain
d Facultad de Medicina y Ciencias de la Salud. Universidad de Oviedo, Oviedo, Spain
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Héctor Cubero-Gallego, Pablo Avanzas
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Tables (5)
Table 1. Clinical and analytical characteristics and follow-up on the population stratified according to diagnosis.
Table 2. Clinical and analytical characteristics of the population according to diagnosis and study phase.
Table 3. Procedures and treatment according to diagnosis and inclusion phase.
Table 4. Follow-up and cardiovascular events according to diagnosis and inclusion phase.
Table 5. Multivariate analysis of all-cause mortality at the end of follow-up in STE-ACS and NSTE-ACS.
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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:
ST-elevation acute coronary syndrome
Non-ST-elevation acute coronary syndrome
Acute myocardial infarction
Percutaneous coronary intervention
Infarction code
Mortality
Resumen
Objetivo

Analizar el pronóstico y mortalidad de los pacientes ingresados en un hospital por síndrome coronario agudo antes y después de la implantación de la unidad coronaria, la sala de hemodinámica y el programa de angioplastia primaria (Código corazón).

Métodos

Estudio observacional y retrospectivo. Se analizaron las características epidemiológicas, las estrategias de reperfusión, los eventos adversos cardiovasculares y la mortalidad durante 5 años de seguimiento. Los resultados del periodo post-código (1 marzo 2012-31 diciembre 2012; n=471) se compararon con la etapa precódigo (1 marzo 2009-31 diciembre 2009; n=432).

Resultados

No hubo diferencias en las características basales de ambos grupos, pero en la fase poscódigo se observó un incremento del síndrome coronario agudo con elevación del ST (SCACEST) del 17,6 al 34,8% (p<0,001). Se generalizó el intervencionismo coronario percutáneo, que alcanzó cifras del 64,8% en el síndrome coronario agudo sin elevación del ST (SCASEST) y del 95,5% en el SCACEST. Se redujeron los reingresos (38,2 vs. 25,1% en el SCASEST, p=0,001 y 23,7 vs. 11% en el SCACEST, p=0,018), la variable pronóstica combinada de eventos adversos cardiovasculares y mortalidad en 5 años de seguimiento (58,7 vs. 45%, p=0,001 en el SCASEST y 40,8 vs. 23,8%, p=0,009 en el SCACEST) y, además, en el SCACEST disminuyó la mortalidad a los 30 días (11,8 vs. 3,7%, p=0,021).

Conclusiones

Con los cambios estructurales realizados en el hospital se ha generalizado el intervencionismo coronario percutáneo y ha mejorado el pronóstico de los pacientes con síndrome coronario agudo, disminuyendo los ingresos, los eventos adversos cardiovasculares y la mortalidad.

Palabras clave:
Síndrome coronario agudo con elevación del ST
Síndrome coronario agudo sin elevación del ST
Infarto agudo de miocardio
Intervencionismo coronario percutáneo
Código infarto
Mortalidad

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