Reduction in Mortality as a Result of Direct Transport From the Field to a Receiving Center for Primary Percutaneous Coronary Intervention

May, Michel R. Le; Wells, George; So, Derek; Glover, Chris; Froeschl, Michael; Maloney, Justin; Dionne, Richard; Marquis, Jean-François; O'Brien, Edward R.; Dick, Alexander; Sherrard, Heather; Trickett, John; Poirier, P.; Blondeau, M; Bernick, Jordan; Labinaz, Marino

doi:10.1016/j.jacc.2012.07.008

Cited by 67 publications

(31 citation statements)

References 27 publications

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“…6-8 Prehospital ECGs reduce the time from first medical contact to device activation, or “balloon” time (FMC2B), which is the first attempt to mechanically open the culprit lesion and restore blood flow. 9-13 However, the relative influence of the patient's distance from the PCI center on FMC2B time is unclear.…”

Section: Introductionmentioning

confidence: 99%

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: Introductionmentioning

confidence: 99%

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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“…The University of Ottawa Heart Institute regional STEMI program serves a population of approximately 1.3 million residents in eastern Ontario, receiving patients from 17 referral hospitals as well as direct transport by paramedics from the field [13]–[15]. The current study was a prospective observational cohort study performed on consecutive eligible patients referred for PPCI between June 2012 and November 2012.…”

Section: Methodsmentioning

confidence: 99%

A Comparative Pharmacodynamic Study of Ticagrelor versus Clopidogrel and Ticagrelor in Patients Undergoing Primary Percutaneous Coronary Intervention: The CAPITAL RELOAD Study

et al. 2014

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BackgroundIn patients undergoing primary percutaneous coronary intervention (PPCI) ticagrelor is superior to clopidogrel in reducing cardiovascular events. This study sought to evaluate the effect of clopidogrel pretreatment on the pharmacodynamics of ticagrelor in patients undergoing PPCI.MethodsWe measured platelet reactivity using the VerifyNow P2Y12 assay at baseline, 1, 2, 4, 6, 12, 24, and 48 hours following ticagrelor bolus in patients previously loaded with clopidogrel (C+T) and in thienopyridine-naive patients (T) referred to our centre for PPCI.ResultsIn total, 52 consecutive eligible patients with ST-elevation myocardial infarction (STEMI) were enrolled (27 C+T and 25 T). Baseline characteristics and mean baseline platelet reactivity units (PRUs) were similar between the groups. The primary endpoint, the proportion of patients achieving a PRU<208 at 2 hours, was more frequently achieved in the C+T group compared to T treatment (76.0% vs 44.4%, p = 0.026). Notably, C+T therapy resulted in fewer patients with high platelet reactivity at 1 hour (56.0% vs. 14.8%), 4 hours (100.0% vs. 61.5%) and 6 hours (100.0% vs. 64%, p<0.01 for all comparisons). Furthermore, C+T therapy was associated with lower PRU values from 2 to 48 hours.ConclusionsIn patients referred for PPCI, ticagrelor bolus following clopidogrel resulted in more rapid and profound platelet inhibition, demonstrating a positive pharmacodynamic interaction. Further study is needed to determine if this pharmacodynamic effect translates into reduced clinical events.

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“…In the past year, evidence has emerged that direct transport of STEMI patients to a more distant PCI capable center (rather than to a nearer non-PCI center) leads to shorter overall reperfusion times and increased adherence to standard guidelines [5]. Additionally, retrospective analysis data comparing the two triage strategies has suggested that mortality may also be considerably reduced with direct transfer to a PCI center, bypassing the non-PCI center [6]. In a French registry, significant reductions in mortality were noted between 1995 and 2010, largely attributed to reductions in time from symptom onset to first medical contact, greater use of reperfusion therapy, and guideline recommended pharmacotherapy [7].…”

Section: Improved Systems Of Care For Stemimentioning

confidence: 99%

Recent advances in treatment of acute coronary syndromes

Aggarwal¹,

Menon²

2013

F1000Prime Rep

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In this manuscript we highlight recent advances in the management of acute coronary syndromes. Efforts to minimize myocardial ischemia time through improved health care systems have resulted in significant success. In addition, new evidence in the areas of reperfusion therapy and pharmacological intervention has emerged. Percutaneous coronary intervention continues to evolve and new data concerning the superiority of the radial route, the use of improved stents and adjunctive therapy will be presented. We will highlight the changes that were made in international guidelines (from the American College of Cardiology/American Heart Association and the European Society of Cardiology) in the last 18 months in order to incorporate the latest evidence. Although significant advancements have been made in the management of acute coronary syndromes, the morbidity and mortality associated with this condition remains high, necessitating continued research in this field of cardiovascular medicine.

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Reduction in Mortality as a Result of Direct Transport From the Field to a Receiving Center for Primary Percutaneous Coronary Intervention

Abstract: A STEMI system allowing EMS to transport patients directly to a primary PCI center was associated with a significant reduction in mortality. Our results support the concept of STEMI systems that include pre-hospital referral by EMS.

Cited by 67 publications

References 27 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

A Comparative Pharmacodynamic Study of Ticagrelor versus Clopidogrel and Ticagrelor in Patients Undergoing Primary Percutaneous Coronary Intervention: The CAPITAL RELOAD Study

Recent advances in treatment of acute coronary syndromes

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