Angioplastia primaria en el Área Norte de Galicia: cambios asistenciales y resultados tras la implantación del programa PROGALIAM / Primary angioplasty in northern Galicia: care changes and results following implementation of the PROGALIAM protocol

Introducción y objetivos. Analizar los resultados y cambios asistenciales del programa de angioplastia primaria del Complejo Hospitalario Universitario A Coruña tras iniciar el Programa Gallego de Atención al Infarto de Miocardio (PROGALIAM). Métodos. Registro observacional de 1.434 pacientes remitidos para angioplastia primaria entre 2003 y 2007. Los resultados de la era PROGALIAM (de mayo de 2005 a diciembre de 2007; n = 963) se compararon con los de la etapa previa (de enero de 2003 a abril de 2005; n = 388). Resultados. Tras iniciar el PROGALIAM, aumentó el número de casos de angioplastia primaria (etapa previa, 14,4 casos/mes; PROGALIAM, 32,3 casos/mes), la media de edad (etapa previa, 61,3 ± 11,9 años; PROGALIAM, 64,2 ± 11,7 años; p < 0,001) y la proporción de pacientes procedentes de hospitales periféricos y pacientes tratados fuera del horario laboral. La mediana de retraso primer contacto-balón se incrementó en el conjunto del programa (etapa previa, 106 min; etapa PROGALIAM, 113 min; p = 0,02), pero se redujo entre los pacientes procedentes de centros secundarios (etapa previa, 171 min; etapa PROGALIAM, 146 min; p < 0,001). La proporción de casos con retraso primer contacto-balón < 120 min permaneció invariable entre los pacientes del centro intervencionista (etapa previa, 69%; etapa PROGALIAM, 71%; p = 0,56) y se incrementó entre los pacientes de centros periféricos, si bien en este subgrupo continuó siendo baja (etapa previa, 17%; etapa PROGALIAM, 30%; p = 0,04). La mortalidad a 30 días (etapa previa, 5,2%; etapa PROGALIAM, 6,2%; p = 0,85) y a 1 año (etapa previa, 9,5%; etapa PROGALIAM, 10,2%; p = 0,96) fue similar en ambas etapas. Conclusiones. El PROGALIAM ha permitido incrementar la proporción de pacientes tratados con angioplastia primaria manteniendo los resultados de esta terapia (AU)

Introduction and objectives. To analyze changes in healthcare delivery and results for primary angioplasty at Centro Hospitalario Universitario A Coruña following implementation of the PROGALIAM protocol. Methods. Observational registry of 1434 patients referred for primary angioplasty between 2003 and 2007. Results under PROGALIAM (May 2005 - December 2007; n=963) were compared with those from the preceding period (January 2003 - April 2005; n=388). Results. After implementing PROGALIAM, there were increases in the number of primary angioplasty procedures (preceding period, 14.4 cases/month; PROGALIAM, 32.2 cases/month), mean patient age (preceding period, 61.3 (11.9) years; PROGALIAM, 64.2 (11.7) years; P<.001), and the percentage of patients referred from peripheral hospitals and treated after normal working hours. Overall median first medical contact-to-balloon time increased (previous period, 106min; PROGALIAM, 113min; P=.02), but decreased significantly among patients referred from noninterventional centers (previous period, 171min; PROGALIAM, 146min; P<.001). Percentage of cases with an first medical contact-to-balloon time <120min remained unchanged among interventional-center patients (preceding period, 69%; PROGALIAM, 71%; P=.56) and increased among patients at noninterventional centers, although it remained low in this subgroup (preceding period, 17%; PROGALIAM, 30%; P=.04). Thirty-day mortality (preceding period, 5.2%; PROGALIAM, 6.2%; P=.85) and 1-year mortality (preceding period, 9.5%; PROGALIAM, 10.2%; P=.96) remained unchanged. Conclusions. Implementation of PROGALIAM allowed us to increase the percentage of patients receiving primary angioplasty without jeopardizing the clinical results of this treatment (AU)

Primary angioplasty in Northern Galicia: care changes and results following implementation of the PROGALIAM protocol.

INTRODUCTION AND OBJECTIVES: To analyze changes in healthcare delivery and results for primary angioplasty at Centro Hospitalario Universitario A Coruña following implementation of the PROGALIAM protocol. METHODS: Observational registry of 1434 patients referred for primary angioplasty between 2003 and 2007. Results under PROGALIAM (May 2005 - December 2007; n=963) were compared with those from the preceding period (January 2003 - April 2005; n=388). RESULTS: After implementing PROGALIAM, there were increases in the number of primary angioplasty procedures (preceding period, 14.4 cases/month; PROGALIAM, 32.2 cases/month), mean patient age (preceding period, 61.3 (11.9) years; PROGALIAM, 64.2 (11.7) years; P<.001), and the percentage of patients referred from peripheral hospitals and treated after normal working hours. Overall median first medical contact-to-balloon time increased (previous period, 106 min; PROGALIAM, 113 min; P=.02), but decreased significantly among patients referred from noninterventional centers (previous period, 171 min; PROGALIAM, 146 min; P<.001). Percentage of cases with an first medical contact-to-balloon time <120 min remained unchanged among interventional-center patients (preceding period, 69%; PROGALIAM, 71%; P=.56) and increased among patients at noninterventional centers, although it remained low in this subgroup (preceding period, 17%; PROGALIAM, 30%; P=.04). Thirty-day mortality (preceding period, 5.2%; PROGALIAM, 6.2%; P=.85) and 1-year mortality (preceding period, 9.5%; PROGALIAM, 10.2%; P=.96) remained unchanged. CONCLUSIONS: Implementation of PROGALIAM allowed us to increase the percentage of patients receiving primary angioplasty without jeopardizing the clinical results of this treatment.