RESUMO
BACKGROUND: Over the last decade, significant advances in ST-elevation myocardial infarction (STEMI) workflow have resulted in most hospitals reporting door-to-balloon (D2B) times within the 90 min standard. Few programs have been enacted to systematically attempt to achieve routine D2B within 60 min. We sought to determine whether 24-hr in-house catheterization laboratory coverage via an In-House Interventional Team Program (IHIT) could achieve D2B times below 60 min for STEMI and to compare the results to the standard primary percutaneous coronary intervention (PCI) approach. METHODS: An IHIT program was established consisting of an attending interventional cardiologist, and a catheterization laboratory team present in-hospital 24 hr/day. For all consecutive STEMI patients, we compared the standard primary PCI approach during the two years prior to the program (group A) to the initial 20 months of the IHIT program (group B), and repeated this analysis for only CMS-reportable patients. The D2B process was analyzed by calculating workflow intervals. The primary endpoint was D2B process times, and secondary endpoints included in-hospital and 6-month cardiovascular outcomes and resource utilization. RESULTS: An IHIT program for STEMI resulted in significant reductions across all treatment intervals with an overall 57% reduction in D2B time, and an absolute reduction in mean D2B time of 71 min. There were no differences pre- and post-program implementation in regard to individual or composite components of in-hospital cardiovascular outcomes; however at 6 months, there was a reduction in cardiovascular rehospitalization after program implementation (30 vs. 5%, P < 0.01). The IHIT program resulted in a significant reduction in length-of-stay (LOS) (90 ± 102 vs. 197 ± 303 hr, P = 0.02), and critical care time (54 ± 97 vs. 149 ± 299 hr, P = 0.02). CONCLUSIONS: Availability of an in-house 24-hr STEMI team significantly decreased reperfusion time and led to improved clinical outcomes and a shorter LOS for PCI-treated STEMI patients.
Assuntos
Cateterismo Cardíaco , Atenção à Saúde , Infarto do Miocárdio/terapia , Intervenção Coronária Percutânea , Avaliação de Processos em Cuidados de Saúde , Tempo para o Tratamento , Plantão Médico , Idoso , Cateterismo Cardíaco/efeitos adversos , Cateterismo Cardíaco/mortalidade , Cateterismo Cardíaco/estatística & dados numéricos , Feminino , Recursos em Saúde/estatística & dados numéricos , Humanos , Illinois , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/mortalidade , Equipe de Assistência ao Paciente , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/mortalidade , Intervenção Coronária Percutânea/estatística & dados numéricos , Avaliação de Programas e Projetos de Saúde , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Fluxo de TrabalhoRESUMO
Coronary artery disease is the leading cause of the death in the United States. From 2009 to 2010, however, the rate of heart disease causing death decreased by 2.5% in part due to evolving techniques used to treat and prevent heart disease. Management of acute ST-segment elevation myocardial infarction (STEMI) has evolved accordingly and the studies investigating treatment strategies that have led to an evidence-based approach are reviewed in this article.
RESUMO
Cell transplantation is a promising way to treat spinal cord injury and neurodegenerative disorders. Neural stem cells taken from the embryonic spinal cord are an appealing source of cells for transplantation because these cells are committed to making spinal cord progeny. However these stem cells are rare and require expansion in tissue culture to generate sufficient cells for transplantation. We have developed a novel method for expanding embryonic mouse spinal cord stem cells using a co-culture system with endothelial cells. This method improves neural stem cell survival and preserves their multipotency, including their ability to make motor neurons. Transplantation of endothelial-expanded neural stem cells that were treated with sonic hedgehog(Shh) and retinoic acid (RA) during the expansion phase, into an adult mouse SCI model resulted in significant recovery of sensory and motor function.