Latest news with #angioplasty
Medscape
16-06-2025
- Health
- Medscape
Missed Target Treatment Times May Increase MI Mortality
When it comes to delivering timely treatment for patients experiencing myocardial infarction (MI), many hospitals are continuing to fall short of national guidelines, new research showed. Benchmarks for percutaneous coronary intervention, the standard of care for acute ST-elevation MI (STEMI), aren't being met in some cases. Delays in care in the key metric of the time from first contact with medical care to angioplasty with stenting resulted in worse patient outcomes and were associated with increased in-hospital mortality risk in some cases, according to the findings, published on June 11 in JAMA Cardiology . 'There are two categories of patient delays: Those that are patient-centered and those that are system-centered,' said Neal S. Kleiman, MD, Houston Methodist DeBakey Heart and Vascular Center, Houston, the senior author of the new study. 'We don't have control over patient-related factors, but there is a lot we can do in terms of hospital systems.' For the retrospective cross-sectional study, Kleiman and his colleagues analyzed data on 73,826 patients with STEMI or STEMI equivalent from 503 sites across the United States. The goal was to determine site-level variability in patterns of treatment times and clinical outcomes from 2020 to 2022 based on an analysis of data from the American Heart Association's Get With the Guidelines — Coronary Artery Disease registry — a quality improvement program for patients with coronary artery disease, acute MI and chest pain. The authors said the study is the first large-scale analysis of treatment goals and outcomes in STEMI based on hospital performance. The researchers found an association between failure to reach the target time from first medical contact with care to angioplasty with stenting — 90 minutes or less — and increased risk for in-hospital mortality for primary presentations and transfers (adjusted odds ratio, 2.21; 95% CI, 2.02-2.42, and 2.44; 95% CI, 1.90-3.12, respectively). Low-performing hospitals were associated with increased risk for mortality and longer stays in the hospital than were high-performing hospitals. However, hospital location and case volume were not associated with worse outcomes. The guidelines recommend a target time from first contact with care to angioplasty with stenting of 90 minutes or less for patients presenting directly to hospitals offering angioplasty with stenting and 120 minutes or less for patients requiring transfer to a facility offering the procedure. The study findings revealed significant variability between hospital sites in meeting the key metric of the recommendations — adherence in at least 75% of patients with STEMI. At hospitals with the capability to perform angioplasty with stenting, the target was met in 72.2% of patients at high-performing sites, 60.8% at intermediate-performing sites, and 46.0% at low-performing sites. When patients required transfers to other facilities with the capability to perform angioplasty, a target first medical contact-to-device treatment time of 120 minutes or less was achieved in 72.3% of patients at high-performing sites, 48.8% at intermediate performing sites, and 21.9% at low-performing sites, according to the researchers. In these hospitals, treatment delays were caused primarily by longer stays in the emergency department and time from arrival in the catheterization laboratory to stenting. Limitations of the study included the fact registry responses were provided on a voluntary basis and may not reflect the totality of STEMI care in all geographical areas, according to the researchers. The analysis also lacked data on follow-up after discharge, making it difficult to extrapolate the findings over the long term, they said. Yasser M. Sammour, MD, MSc, cardiology fellow at Houston Methodist DeBakey Heart and Vascular Center, who led the work, said several decades of research have highlighted the importance of treating patients with STEMI efficiently. A previous registry study found fewer treatment delays were linked to reduced mortality. 'The current study tried to take that research one step further, assessing how factors such as hospital performance and location affect patient outcomes,' Sammour said. The result, he said: 'We're still underperforming. We need to have coordinated strategies with local intervention at the hospital level to examine where significant delays in percutaneous coronary intervention time are occurring.' The absence of uniformity in established performance measures such as time to initiate treatment in STEMI has led to calls for greater adherence to current recommendations. In an editorial accompanying the journal article, Roxana Mehran, MD, Mount Sinai Fuster Heart Hospital in New York City, wrote: 'After two decades of data collection, national initiatives, and public accountability, the next step must involve tailored solutions addressing barriers within each institution. Bridging the gap now requires renewed efforts and commitments to prioritize timely, coordinated STEMI care. Until then, the clock will continue to tick — against our patients.'
Malay Mail
03-06-2025
- General
- Malay Mail
A beacon amidst the bleeding: What Jaffna's doctors taught me about life — Abbi Kanthasamy
JUNE 3 — I've spent most of my adult life building things. Businesses, brands, homes, arguments. Always chasing — the next goal, the next deal, the next piece of validation in a world that measures worth by margins and milestones. But this past week, watching my mother fight for her life in a small hospital in northern Sri Lanka, I was reminded of something I had forgotten: not all heroes chase. It began in Kumulamunai. A heart attack. A real one. Silent but severe. My mother — diabetic, hypertensive, and until that moment, unstoppable — suffered what doctors later described as a near-total occlusion. A 99 per cent block in the right circumflex artery. She had been slipping quietly into danger for days. No textbook symptoms. No drama. Just a quiet march toward a cliff. We may have built a world that worships money. But in those fluorescent-lit hospital wards, I met people who worship life. — Picture courtesy of Abby Kanthasamy The team at Mullaitivu Hospital moved with speed and certainty. They administered a thrombolytic agent — what the rest of us call a 'clot buster' — and bought her precious time. She was then transferred across district lines to Jaffna, where a team of doctors and nurses, in a system with barely enough gloves to go around, performed a high-stakes angioplasty and placed a stent that saved her life. Not once did I hear the word 'payment'. Not once did I feel we were anything but in capable hands. Now here's the part that truly knocked the wind out of me: they didn't have to do any of it. Two thousand doctors have left Sri Lanka in the past three years. They've gone to the UK, Australia, the Middle East — anywhere that offers better pay, better hours, better everything. The doctors who stayed behind? They're the outliers. The stubborn. The selfless. The ones who choose purpose over perks. I spent time with them. I watched them scrub in and out without a pause, without fanfare, without complaint. I saw a cardiologist explain a procedure to an elderly villager in fluent Tamil, without condescension. I watched a nurse adjust a patient's pillow like she was tucking in her own child. I saw joy in the act of healing — real joy, not performative compassion. And I realised something quietly devastating: these people are happier than most of us. There is peace in purpose. A kind of wealth that isn't counted in digits but in dignity. And it is abundant here. My mother was in the ER in Canada just weeks before this trip. High blood pressure. Worrying signs. But the system — hamstrung by protocol and overregulation — missed the looming heart attack. The very thing that a government hospital in war-scarred, budget-strapped northern Sri Lanka caught and treated with surgical precision. I don't say this to score points. I say it because it humbled me. We often talk about what's broken in Sri Lanka. We talk about corruption, collapse, and crisis. And there's truth in that. But somewhere amid the bureaucracy and broken roads is a public healthcare system that works. That shines. That makes you proud. And sometimes, it takes a stent in your mother's heart to see it clearly. Somewhere amid the bureaucracy in Sri Lanka is a public healthcare system that works. — Picture courtesy of Abby Kanthasamy To those doctors in Jaffna and Mullaitivu — to the nurses, the orderlies, the drivers who transported her between towns and hope — I owe more than gratitude. I owe perspective. We may have built a world that worships money. But in those fluorescent-lit hospital wards, I met people who worship life. And they are the richer for it. * This is the personal opinion of the writer or publication and does not necessarily represent the views of Malay Mail.
