Performance of a New “Physician-Less” Automated System of Prehospital ST-Segment Elevation Myocardial Infarction Diagnosis and Catheterization Laboratory Activation

Potter, Brian J.; Matteau, Alexis; Mansour, Samer; Essiambre, R.; Montigny, Martine; Savoie, S.; Gobeil, François

doi:10.1016/j.amjcard.2013.03.005

Cited by 17 publications

(24 citation statements)

References 23 publications

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“…Previous studies suggest that maximum benefit is achieved when a STEMI system utilizes both prehospital ECGs and prehospital cardiac catheterization lab activation. 8,13,21-23 Our data likely reflect system heterogeneity, with some systems consistently utilizing prehospital cardiac catheterization lab activation and emergency department bypass, 16,24 while other systems may rely on emergency physician activation of the cardiac catheterization lab after patient arrival, potentially delaying reperfusion time. This may explain why we found that the reduction in FMC2B was similar for patients presenting on and off hours.…”

Section: Discussionmentioning

confidence: 95%

Association between prehospital electrocardiogram use and patient home distance from the percutaneous coronary intervention center on total reperfusion time in ST-segment–elevation myocardial infarction patients: A retrospective analysis from the National Cardiovascular Data Registry

Mumma¹,

Kontos²,

Peng³

et al. 2014

American Heart Journal

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Background Current guidelines recommend ≤90 minutes from first medical contact (FMC) to percutaneous coronary intervention (FMC2B) for ST segment elevation myocardial infarction (STEMI) patients. We evaluated the relationship between patient home distance from a percutaneous coronary intervention (PCI) center, prehospital electrocardiogram (ECG) use, and FMC2B time among patients with STEMI. Methods We performed a retrospective cohort study including all STEMI patients in the ACTION®-GWTG™ registry from 7/1/2008 to 9/30/2012 who were transported by ambulance to a PCI center. Patient home distance was defined as the driving distance from the patient's home zip code to the PCI center address. Distance was classified into tertiles, and linear regression was used to characterize the interaction between prehospital ECG use and patient home distance with respect to FMC2B time. Results Of the 29,506 STEMI patients, 19,690 (67%) received a prehospital ECG. The median patient home distance to the PCI center was 11.0 miles among patients with and 9.9 miles among those without a prehospital ECG. Prehospital ECGs were associated with a 10-minute reduction in the FMC2B time (p<0.0001), which was consistent across distance tertiles (11 vs 11 vs 10 minutes). The association between prehospital ECGs and shorter FMC2B was attenuated by 0.8 minutes for every 10 mile increase in distance (interaction p=0.0002). Conclusions Prehospital ECGs are associated with a 10-minute reduction in the FMC2B time. However, patient home distance from a PCI center does not substantially change this association.

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Section: Discussionmentioning

confidence: 95%

Association between prehospital electrocardiogram use and patient home distance from the percutaneous coronary intervention center on total reperfusion time in ST-segment–elevation myocardial infarction patients: A retrospective analysis from the National Cardiovascular Data Registry

Mumma¹,

Kontos²,

Peng³

et al. 2014

American Heart Journal

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“…This raises the question of how the ECG interpretation is performed. Automated ECG interpretation algorithms have been suggested as a safe and effective method for diagnosing STEMI [40]. However, the automated algorithms do not detect the STEMI equivalent changes, the error rate is high and sensitivity is generally low [41,42].…”

Section: Prehospital Ecg Diagnosis Of Patients With St Elevation Myocmentioning

confidence: 99%

Prehospital diagnosis of patients with acute myocardial infarction

et al. 2016

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Primary percutaneous intervention (PPCI) is the preferred treatment in patients with ST elevation myocardial infarction (STEMI) if this can be performed in a timely manner. The 2012 ESC Guidelines on management of AMI in patients presenting with ST-segment elevation advice that PPCI should be performed within 120 min of first medical contact. Prehospital diagnosis of patients with STEMI is performed to save time and make PPCI available to the majority of patients. Although diagnosing patients with STEMI is usually easy, there are important pitfalls and patients with STEMI are missed on occasion. In addition, it is well know that patients without ST elevation may also have a high-risk cardiac condition. The 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation stress the importance of urgent CAG in patients with high-risk non ST-segment elevation myocardial infarction (NSTEMI). Unfortunately, these patients are difficult to diagnose in the acute phase and important time may be spend establishing the correct diagnosis. Prehospital biomarker measurement has emerged as a method to gain important additional information. We review the evidence on prehospital diagnosis of patients with STEMI and, In addition, we present the current knowledge on the new diagnostic methods that could have a future role in prehospital rule-in and rule-out of cardiac disease.

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“…In many cases such waves were acceptable to human experts and contributed to their estimation of the mean RRI from the image. Such concerns highlight the importance of human oversight of any RRI automated estimation tool, as previously recognized with similar technologies in other clinical settings (e.g., ST segment analysis) 27 . Inclusion of additional data (e.g., ECG analysis to identify QRS complex timing) in future iterations may be a useful approach to continue to improve our algorithm.…”

Section: Discussionmentioning

confidence: 91%

Intraoperative Renal Resistive Index as an Acute Kidney Injury Biomarker: Development and Validation of an Automated Analysis Algorithm

Andrew

Cherry

et al. 2018

Journal of Cardiothoracic and Vascular Anesthesia

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Performance of a New “Physician-Less” Automated System of Prehospital ST-Segment Elevation Myocardial Infarction Diagnosis and Catheterization Laboratory Activation

Cited by 17 publications

References 23 publications

Association between prehospital electrocardiogram use and patient home distance from the percutaneous coronary intervention center on total reperfusion time in ST-segment–elevation myocardial infarction patients: A retrospective analysis from the National Cardiovascular Data Registry

Association between prehospital electrocardiogram use and patient home distance from the percutaneous coronary intervention center on total reperfusion time in ST-segment–elevation myocardial infarction patients: A retrospective analysis from the National Cardiovascular Data Registry

Prehospital diagnosis of patients with acute myocardial infarction

Intraoperative Renal Resistive Index as an Acute Kidney Injury Biomarker: Development and Validation of an Automated Analysis Algorithm

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