The impact of prehospital activation of the cardiac catheterization team on time to treatment for patients presenting with ST-segment-elevation myocardial infarction

Camp-Rogers, Teresa; Dante, Siddhartha; Kontos, Michael C.; Roberts, Charlotte; Kreisa, Laura; Kurz, Michael C.

doi:10.1016/j.ajem.2010.08.005

Cited by 46 publications

(26 citation statements)

References 39 publications

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“…Cone, et al ., showed that prehospital ECGs combined with prehospital cardiac catheterization lab activation reduced door to balloon time by 50 minutes, from 87 to 37 minutes, 16 and Camp-Rogers, et al ., demonstrated a 22-minute reduction in FMC2B time with prehospital cardiac catheterization lab activation. 10 In contrast, the 64% rate of patients with a prehospital ECG who met the 90-minute FMC2B goal in our study was similar to the 68% rate reported from five organized regional STEMI networks. 13,17 In our data, prehospital ECGs were associated with a 12-minute reduction in door-to-balloon time (61 vs 50 minutes), with the difference between groups being a shorter time from hospital arrival to cardiac catheterization lab arrival and shorter door to balloon time for those with prehospital ECGs.…”

Section: Discussionsupporting

confidence: 80%

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: Discussionsupporting

confidence: 80%

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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“…52 Field activation of the catheterization laboratory while the patient is en route to the hospital has been associated with 14 to 43 minute shorter reperfusion times compared with waiting for hospital arrival before catheterization laboratory activation, with the greatest benefits during off-hours and for patients with long transport times. 19,[53][54][55][56] Although paramedics can reliably interpret STEMI on prehospital ECGs and this is the most common means of field diagnosis of STEMI, 57,58 uptake of catheterization laboratory activation by paramedics has been impeded in some regions by concerns about high false activation rates. With enhanced paramedic training and use of computerized programs for ECG interpretation, similar catheterization laboratory activation cancellation rates have been demonstrated for paramedic and ED physicians.…”

Section: Prehospital Ecg and Catheterization Laboratory Activationmentioning

confidence: 99%

Reperfusion Strategies in Acute Coronary Syndromes

Bagai

Dangas

Stone

et al. 2014

Circulation Research

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The appropriate timing of angiography to facilitate revascularization is essential to optimize outcomes in patents with ST-segment–elevation myocardial infarction and non–ST-segment–elevation acute coronary syndromes. Timely reperfusion of the infarct-related coronary artery in ST-segment–elevation myocardial infarction both with fibrinolysis or percutaneous coronary intervention minimizes myocardial damage, reduces infarct size, and decreases morbidity and mortality. Primary percutaneous coronary intervention is the preferred reperfusion method if it can be performed in a timely manner. Strategies to reduce health system–related delays in reperfusion include regionalization of ST-segment–elevation myocardial infarction care, performing prehospital ECGs, prehospital activation of the catheterization laboratory, bypassing geographically closer nonpercutaneous coronary intervention–capable hospitals, bypassing the percutaneous coronary intervention–capable hospital emergency department, and early and consistent availability of the catheterization laboratory team. With implementation of such strategies, there has been significant improvement in process measures, including door-to-balloon time. However, despite reductions in door-to-balloon times, there has been little change during the past several years in in-hospital mortality, suggesting additional factors including patient-related delays, optimization of tissue-level perfusion, and cardioprotection must be addressed to improve patient outcomes further. Early angiography followed by revascularization when appropriate also reduces rates of death, MI, and recurrent ischemia in patients with non–ST-segment–elevation acute coronary syndromes, with the greatest benefits realized in the highest risk patients. Among patients with non–ST-segment–elevation acute coronary syndromes with multivessel disease, choice of revascularization modality should be made as in stable coronary artery disease, with a goal of complete ischemic revascularization.

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“…Several regional programs with this purpose have shown promising results, 8---11 and various prehospital primary PCI activation strategies (similar to that initiated in our hospital, but with smaller sample sizes) have achieved improvements in ischemia times. 12,13 SD is the best ischemia time interval to evaluate a regional primary PCI network, as it involves the coordination of all of the network's components. Furthermore, it is directly related to in-hospital mortality in STEMI.…”

Section: Discussionmentioning

confidence: 99%

Prehospital activation of cardiac catheterization teams in ST-segment elevation myocardial infarction

Franco

Mateos

Acebal

et al. 2014

Revista Portuguesa de Cardiologia

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The impact of prehospital activation of the cardiac catheterization team on time to treatment for patients presenting with ST-segment-elevation myocardial infarction

Cited by 46 publications

References 39 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

Reperfusion Strategies in Acute Coronary Syndromes

Prehospital activation of cardiac catheterization teams in ST-segment elevation myocardial infarction

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