Abstract:
Introducción: La cardiopatía isquémica es la principal causa de muerte en los países
desarrollados, representando el IAMCEST la manifestación más aguda de la enfermedad
coronaria. Una demora en la aplicación del tratamiento es uno de los factores que influyen directamente en la mortalidad, siendo d... Ver más
Background: Ischemic heart disease is the leading cause of death in developed countries, with STEMI being the most acute manifestation of coronary disease. A delay in the application of treatment is one of the factors that directly influence mortality, with primary percutaneous coronary intervention being the preferred option. The delay time from the onset of symptoms to balloon and door-to-balloon time, among other existing delay times, can be altered by multiple factors that aim to be studied with this umbrella review.
Objective: To identify the factors associated with the delay of STEMI treatment from the first medical contact to treatment and from the onset of symptoms to treatment.
Material and methods: We searched four databases (EMBASE, SCOPUS, MEDLINE, COCHRANE LIBRARY). Two reviewers independently reviewed titles and abstracts of the systematic reviews found using the Rayyan platform. The selected reviews were downloaded and uploaded to the Rayyan platform, where two reviewers assessed whether the met the selection criteria by reading full text. In both phases a third reviewer resolved possible discrepancies. The search was conducted on 26 December 2023. Results: A total of 24 systematic reviews published from 2012 to 2023 were included. 60% of the reviews combine experimental and observational studies. The population studied were adults with STEMI. In 29% of the studies, the influence of COVID-19 on delay time was evaluated, in 20% the performance of pre-hospital ECG triage, in 12.5% the sex, and, in smaller percentages, the presentation outside normal working hours, hypothermic therapy, pre-hospital activation of the cath lab, the type of access for PCI and other factors. Door-to-balloon time was analyzed in more than 90% of studies, followed by the time from the onset of symptoms to balloon (total ischemia time) in 30%. Most reviews performed meta-analysis of the data obtained.
Conclusion: The presence of concomitant COVID-19, the presentation during the pandemic, hypothermic therapy and the female sex increase the delay time. In contrast, the use of prehospital ECG and prehospital activation of the cath lab reduce it. The presentation outside normal working hours and the choice of the type of access for PCI were considered indifferent.
|