Barriers and Procedures to Reduce Treatment Delay in ST-Segment Elevation Acute Coronary Syndrome with Primary Percutaneous Coronary Intervention. 20-Year Experience of a Tertiary Care Center in a Densely Populated City

espanolIntroduccion: La demora a la reperfusion del sindrome coronario agudo con elevacion del segmento ST es un factor determinanteen el pronostico. Su reduccion podria disminuir la morbimortalidad.Objetivo: Identificar y modificar las barreras detectadas en 20 anos de tratamiento del sindrome coronario agudo con elevaciondel segmento ST en un centro de tercer nivel de una ciudad de alta densidad demografica para evaluar su efecto en elresultado del procedimiento.Material y metodos: Incluimos prospectiva y consecutivamente del 01/01/2000 al 31/12/2019, 3007 pacientes con sindromecoronario agudo con elevacion del segmento ST dentro de las 12 h de iniciados los sintomas para realizar angioplastia primaria.Se dividio el tiempo desde el comienzo de los sintomas hasta la insuflacion del balon en intervalos.Luego de identificar las barreras (2000-2009) se incorporaron cambios al procedimiento. Se organizo a la poblacion en 2 grupos(G) G1: preimplementacion de cambios (2000-2009) y G2: posimplementacion (2010- 2019).Resultados: Se incluyeron en G1 1409 pacientes y en G2 1598. Sin diferencias demograficas, excepto por el tipo de angioplastia.Se identificaron demoras al realizar el diagnostico, de comunicacion entre medicos, del traslado y del ingreso del paciente a hemodinamia.Con los cambios, disminuimos el intervalo consulta-contacto con el hemodinamista [G1: 90 min (36-168) vs. G2: 77min (36-144) p –0,01] y el intervalo contacto hemodinamista-ingreso a Hemodinamia [G1: 75 min (55-100) vs. G2: 51 min (34-70)p –0,01]. Se redujo la mortalidad intrahospitalaria (G1: 9,2% vs. G2:6,7% p –0,01) y al 6to mes (G1: 13,1% vs. G2: 7,5% p –0,01).Conclusiones: El retraso al diagnostico, la dificultad en la comunicacion y la forma de traslado fueron las principales causas dedemora. La implementacion de un protocolo de procedimientos permitio reducir las demoras. La evaluacion continua de resultadosy la educacion permanente, constituyen los pilares fundamentales para la optimizacion de programas de atencion en red. EnglishBackground: The delay to reperfusion of ST-segment elevation acute coronary syndrome (STEACS) is a key factor in itsprognosis, and its reduction could reduce morbidity and mortality.Objective: The aim of this study was to identify and modify the barriers detected in 20 years of STEACS treatment in a tertiarycare center of a densely populated city to evaluate their effect on the outcome of the procedure.Methods: A total of 3007 patients with STEACS within 12 hours of symptoms onset were prospectively and consecutivelyincluded to undergo primary percutaneous coronary intervention (PCI) from January 1, 2000 to December 31, 2019. Time fromsymptoms onset to balloon inflation was divided into intervals. After barriers were identified (2000-2009), the procedure waschanged. The population was divided into two groups (G) G1: pre-implementation (2000-2009) and G2: post-implementation(2010-2019) of changes.Results: G1 included 1409 and G2 1598 patients with no demographic differences except for the type of PCI. Delays wereidentified in diagnosis, communication between physicians, transfer and admission of the patient to the hemodynamics lab.Procedural changes decreased first medical contact-hemodynamic team contact interval [G1: 90 min (36-168) vs. G2: 77 min(36-144) p –0.01] and hemodynamic team contact-hemodynamics lab admission interval [G1: 75 min (55-100) vs. G2: 51 min(34-70) p –0.01] and reduced in-hospital (G1: 9,2% vs. G2: 6,7% p –0,01) and 6-month (G1: 13.1% vs. G2: 7.5% p –0. 01) mortality.Conclusions: Delay in diagnosis, difficulty in communication and type of transfer were the most important causes of delay.Implementing a procedural protocol reduced delays. Continuous evaluation of results and permanent education constitutethe fundamental cornerstones for optimizing network care programs.