45 year old male with “numb hands” – Discussion

Go back to 45 year old male with “numb hands” to read about the presentation, and see the ECGs.   The culprit artery? After arriving at the hospital, the patient bypassed the ED, going directly to the cardiac catheterization lab. The patient was found to have a total occlusion of the proximal RCA, and the cardiologist was able to deploy a stent without problem.   Excellent D2B, but … Despite prompt activation of the 911 system, excellent EMS care, field activation of the cath lab, and an uncomplicated percutaneous coronary intervention, he was left with moderate ventricular dysfunction. The system “did everything right,” but the patient still had significant heart damage – why?   Faster STEMI treatment, but no change in mortality? A recent study in the New England Journal of Medicine describes this question on a larger scale. The authors of  “Door-to-Balloon Time and Mortality among Patients Undergoing Primary PCI” found that, although D2B times for STEMI have decreased significantly over the past few years, the mortality for STEMI hasn’t changed. The researchers looked at 515 hospitals across the country, using a Medicare database. Over a period of 4 years, the percent of STEMI patients who received PCI within 90 minutes of hospital arrival increased from 60% to 83%. Unfortunately, mortality rates in those STEMI patients did not change. Even when they looked only at the high-risk sub-groups (> 75 years-old, anterior infarct, or ca...
Source: EMS 12-Lead - Category: Cardiology Authors: Tags: Uncategorized Source Type: research