INTRODUCTION

ST-segment elevation myocardial infarction (STEMI) is a common and potentially fatal presentation of cardiovascular disease. Once a diagnosis is made, prompt intervention is crucial, with substantial effect on morbidity and even mortality.

The aim of this study was to assess the adherence of physicians of a tertiary care hospital to American College of Cardiology/American Heart Association and European Society of Cardiology performance measures for the management of acute STEMI patients. 

This was a descriptive retrospective chart review of acute STEMI patients seen in a tertiary care hospital over a 2-year period.

A total of 118 STEMI patients were included in the study. Mean age was 57.8 years with male predominance. High adherence rates (100% achievement score) to recommended discharge medications and counseling for smoking cessation were observed. However, performance measures for time to reperfusion therapy via percutaneous coronary intervention (average, 16.7% over 2 years) and referral to cardiac rehabilitation (average, 38.0%) were consistently low, although time to percutaneous coronary intervention improved from an average of 170 minutes to 142 minutes in the second year of this study.

For 2 consecutive years, all STEMI patients seen in our institution were adequately managed with regard to recommended medications. All patients have been advised lifestyle change, particularly smoking cessation for current smokers. There is room for improvement with regards to time to reperfusion therapy and referral to cardiac rehabilitation. Some measures have been suggested, including shortening the time to secure patient consent.

Introduction. Coronary artery disease (CAD) remains a significant public health problem worldwide and in the Philippines. Adherence to guideline-directed therapy improves the quality of care (QOC).

Objective. We aimed to evaluate the QOC initially received by ST-Elevation Myocardial Infarction (STEMI) patients at our Emergency Room (ER), based on compliance to 2014 PHA CAD guidelines recommendations.

Methods. We reviewed the charts of adult patients with STEMI admitted at the ER who were not previously managed in a different hospital. The primary outcome was QOC assessed through quality indicators (QI) based on class I and IIa recommendations in the PHA CAD guidelines.

Results. Of the 29 patients included, all had ECG done upon admission, but only four were done within 10 minutes (QI: 13.79%). All eligible patients received antiplatelets (QI: 100%). Six eligible patients (QI: 100%) received nitrates, and four eligible patients (QI: 100%) received morphine. Of 16 eligible patients, only six were reperfused within the recommended 12 hours of ischemia (QI: 37.5%), two by thrombolysis and four by the primary percutaneous coronary intervention (PCI).

Conclusion. The timely performance of initial ECG and reperfusion need improvement. Suitable performance measures for the provision of nitrates and morphine to eligible patients were met. Investigating intrinsic and extrinsic factors that lead to the time delays observed are also recommended.

Electrocardiography ; Humans ; ST Elevation Myocardial Infarction/therapy*

Background: Ischemic heart disease is the leading cause of mortality and morbidity worldwide. The COVID-19 pandemic changed healthcare-seeking behavior and healthcare delivery. Methods: This is a single-center, retrospective cohort study using a non-probability sampling of adult patients at the Philippine Heart Center who were diagnosed with ACS-STEMI. Baseline characteristics, clinical profile, management plan, and outcomes of patients were determined and analyzed in both periods. Results: 170 STEMI patients during each period were included in the study. The mean time for the onset of symptoms to consult was 8 hours in both periods. Majority of STEMI patient had undergone primary PCI in both periods. There is a significant decline in the number of patients undergoing primary PCI during the COVID 19 period (n=116, 68%). Fibrinolysis was performed more during the COVID 19 pandemic (n=9, 5%) and none in the pre-COVID 19 period. There was a statistically significant delay in the door-to-wiring time during the pandemic. Composite outcome was significantly higher during this time with 42 patients (25%, p=0.029). Composite outcomes were also higher in STEMI patients with COVID-19 infection (OR 1.9, 95% CI 1.0989 - 3.2960, p=0.022). Conclusion The study confirmed that there was an increase in the rate of fibrinolysis and medical therapy alone during the COVID-19 period. There was also a significant delay in the door-to-wiring time as well as an increase in composite outcomes during the COVID-19 pandemic.
ST Elevation Myocardial Infarction ; COVID-19

Electrocardiography ; Humans ; Myocardial Reperfusion ; ST Elevation Myocardial Infarction/therapy*

Background: The diagnosis of ST-elevation myocardial infarction on standard 12-lead electrocardiography is crucial to the timely institution of appropriate medical therapies and interventions. However, the electrocardiographic diagnosis may be prone to observer variability. Objectives: We wanted to determine the 1) inter-observer variability among clinicians from a training hospital in the diagnosis of ST-elevation myocardial infarction (STEMI) from emergency room electrocardiograms (ECG) of patients presenting with chest pain, and 2) the accuracy of clinician readings compared to the final cardiac diagnosis in the official patient records Methods: Forty electrocardiograms were independently interpreted by 40 clinicians which included 10 cardiologists (CC), 5 cardiology fellows (CF). 15 internal medicine (IM), and 10 internal medicine residents (MR), using uniform copies of the standard 12-lead electrocardiogram print-outs. All readers were blinded to the patient's clinical profile. The accuracy of clinician readings (% of tracings correctly identified as STEMI) were compared against a reference standard, which was the final cardiac diagnosis made based on historical, electrocardiographic, biochemical, and angiographic data. Results: The overall level of agreement among all readers (intergroup variability) was only fair with a kappa of 0.24. The level of agreement within the groups (intra-group variability) was likewise "fair" for the IM (0.35), MR (0.32), and CC (0.30 groups. Agreement was much less (0.18) among the cardiology fellows (0.18) among the cardiology fellows (CF). Accuracy of ECG diagnosis varied among the groups: IM (68%), MR (60%), CF (52%) and CC (50%). Conclusions There is substantial inter-group variability in the electrocardiographic diagnosis of STEM by clinicians. The accurate diagnosis of STEMI, based on pure electrocardiographic informa-tion, varied among readers with different training backgrounds. These findings suggest that the electrocardiographic diagnosis of STEM may be influenced by training background and experience. as well as presence or absence of supplemental medical information necessary to make a comprehensive and accurate cardiac diagnosis. More importantly, this underscores the need to harmonize electrocardiographic interpretations and recognize the value of reading ECGs in light of pertinent clinical data
ST Elevation Myocardial Infarction ; Emergency Service, Hospital ; Electrocardiography

Humans ; ST Elevation Myocardial Infarction/diagnostic imaging* ; Percutaneous Coronary Intervention

Humans ; Hemoptysis ; Myocardial Infarction/therapy* ; Percutaneous Coronary Intervention/adverse effects* ; Treatment Outcome ; ST Elevation Myocardial Infarction

The de Winter electrocardiogram pattern is an acute ST-segment elevation myocardial infarction equivalent, however this specific electrocardiogram change is easily ignored by clinicians. The de Winter electrocardiogram pattern in patients with acute chest pain mostly indicates sub-complete or complete occlusion of the left anterior descending or the diagonal branch. Patients with acute chest pain and such electrocardiographic finding should undergo emergency coronary angiography immediately to determine the coronary condition, and reperfusion therapy should be performed as soon as possible to reduce the incidence of adverse cardiovascular events.
Anterior Wall Myocardial Infarction ; Cognition ; Coronary Angiography ; Electrocardiography ; Humans ; ST Elevation Myocardial Infarction/diagnosis*

Humans ; ST Elevation Myocardial Infarction ; Microcirculation ; Myocardial Infarction ; Coronary Circulation ; Vascular Resistance ; Percutaneous Coronary Intervention