Catheterization laboratory activations and time intervals for patients with pre-hospital ECGs

Muhrbeck, Josephine; Persson, Jonas; Hofman-Bang, Claes

doi:10.1080/14017431.2018.1430899

Cited by 7 publications

(1 citation statement)

References 24 publications

(47 reference statements)

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“…Prenotification was initiated less often in women with STEMI, consistent with previous studies that have found delays in diagnosis and treatment17 18 and increased in-hospital mortality19 among women with STEMI. In particular, studies have found that prehospital treatment is delayed in women,19 20 as is time from first medical contact to performance of the diagnostic ECG 21. It is uncertain why cases with RCA occlusion were most commonly represented in group 1 but may relate to more obvious ECG changes, even without 12-lead capability.…”

Section: Discussionmentioning

confidence: 99%

Predictors of hospital prenotification for STEMI and association of prenotification with outcomes

et al. 2021

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BackgroundDelay to reperfusion in ST-elevation myocardial infarction (STEMI) is detrimental, but can be minimised with prehospital notification by ambulance to the treating hospital. We aimed to assess whether prenotification was associated with improved first medical contact to balloon times (FMC-BT) and whether this resulted in better clinical outcomes. We also aimed to identify factors associated with use of prenotification.MethodsThis was a retrospective study of prospective Victorian Cardiac Outcomes Registry data for patients undergoing primary percutaneous coronary intervention for STEMI from 2013-2018. Postcardiac arrest were excluded. Patients were grouped by whether they arrived by ambulance with prenotification (group 1), arrived by ambulance without prenotification (group 2) or self-presented (group 3). We compared groups by FMC-BT, incidence of major adverse cardiac and cerebrovascular events (MACCE), mortality and factors associated with the use of prenotification.Results2891 patients were in group 1 (79.3% male), 1620 in group 2 (75.7% male) and 1220 in group 3 (82.9% male). Patients who had prenotification were more likely to present in-hours (p=0.004) and self-presenters had lowest rates of cardiogenic shock (p<0.001). Prenotification had shorter FMC-BT than without prenotification (104 min vs 132 min, p<0.001) Self-presenters had superior clinical outcomes, with no difference between ambulance groups. Groups 1 and 2 had similar 30-day MACCE outcomes (7.4% group 1 vs 9.1% group 2, p=0.05) and similar mortality (4.6% group 1 vs 5.9% group 2, p=0.07). In multivariable analysis, male gender, right coronary artery culprit and in-hours presentation independently predicted use of prenotification (all p<0.05).ConclusionDifferences in clinical characteristics, particularly gender, time of presentation and culprit vessel may influence ambulance prenotification. Ambulance cohorts have high-risk features and worse outcomes compared with self-presenters. Improving system inequality in prehospital STEMI diagnosis is recommended for fastest STEMI treatment.

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