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Title: Assessment of distance to primary percutaneous coronary intervention centres in ST-segment elevation myocardial infarction: Overcoming inequalities with process mining tools
Authors: Borges-Rosa, João
Oliveira-Santos, Manuel 
Simões, Marco A. 
Carvalho, Paulo 
Ibanez-Sanchez, Gema
Fernandez-Llatas, Carlos
Costa, Marco 
Monteiro, Sílvia
Gonçalves, Lino 
Keywords: Big data analytics; ST-segment elevation myocardial infarction; percutaneous coronary intervention; clinical pathways; process mining tools
Issue Date: 2023
Serial title, monograph or event: Digital Health
Volume: 9
Abstract: Objectives: In ST-segment elevation myocardial infarction (STEMI), time delay between symptom onset and treatment is critical to improve outcome. The expected transport delay between patient location and percutaneous coronary intervention (PCI) centre is paramount for choosing the adequate reperfusion therapy. The “Centro” region of Portugal has heterogeneity in PCI assess due to geographical reasons. We aimed to explore time delays between regions using process mining tools. Methods: Retrospective observational analysis of patients with STEMI from the Portuguese Registry of Acute Coronary Syndromes. We collected information on geographical area of symptom onset, reperfusion option, and in-hospital mortality. We built a national and a regional patient’s flow models by using a process mining methodology based on parallel activitybased log inference algorithm. Results: Totally, 8956 patients (75% male, 48% from 51 to 70 years) were included in the national model. Most patients (73%) had primary PCI, with the median time between admission and treatment <120 minutes in every region; “Centro” had the longest delay. In the regional model corresponding to the “Centro” region of Portugal divided by districts, only 61% had primary PCI, with “Guarda” (05:04) and “Castelo Branco” (06:50) showing longer delays between diagnosis and reperfusion than “Coimbra” (01:19). For both models, in-hospital mortality was higher for those without reperfusion therapy compared to PCI and fibrinolysis. Conclusion: Process mining tools help to understand referencing networks visually, easily highlighting its inefficiencies and potential needs for improvement. A new PCI centre in the “Centro” region is critical to offer timely first-line treatment to their population.
ISSN: 2055-2076
DOI: 10.1177/20552076221144210
Rights: openAccess
Appears in Collections:I&D CISUC - Artigos em Revistas Internacionais
FMUC Medicina - Artigos em Revistas Internacionais

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