Impact of Prehospital Electrocardiogram Protocol and Immediate Catheterization Team Activation for Patients With ST-Elevation–Myocardial Infarction

Nestler, David M.; White, Roger D.; Rihal, Charanjit S.; Myers, Lucas A.; Bjerke, Christine M.; Lennon, Ryan J.; Schultz, Jeffery L.; Bell, Malcolm R.; Gersh, Bernard J.; Holmes, David R.; Ting, Henry H.

doi:10.1161/circoutcomes.111.961433

Cited by 16 publications

(5 citation statements)

References 27 publications

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“…Despite these prior paradoxical data, efforts to shorten the total ischemic time for STEMI patients could improve overall mortality rate. To achieve more prompt and accurate triage, various novel approaches such as pre-hospital electrocardiogram or pre-hospital troponin T testing have been attempted and their effects reported [28][29][30][31][32][33][34][35].…”

Section: Discussionmentioning

confidence: 99%

Impact of transport pathways on the time from symptom onset of ST-segment elevation myocardial infarction to door of coronary intervention facility

Fujii

Masuda

Suzuki

et al. 2014

Journal of Cardiology

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Self-transportation without EMS and inter-hospital transportation were significant factors causing prolongation of the OTD time. Approximately 35% of STEMI patients did not use EMS and 21% of patients were transported to non-PCI facilities even though they called EMS. Awareness in the community as well as among medical professionals to reduce total ischemic time of STEMI is necessary; this involves educating the general public and EMS crews.

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Section: Discussionmentioning

confidence: 99%

Impact of transport pathways on the time from symptom onset of ST-segment elevation myocardial infarction to door of coronary intervention facility

Fujii

Masuda

Suzuki

et al. 2014

Journal of Cardiology

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“…Numerous studies document the implementation of regional 12-lead electrocardiogram (ECG)-based prehospital triage systems with subsequent reductions in door-to-balloon time and ischemic time. [6][7][8][9] However, the proportion of STEMI patients diagnosed by these prehospital triage systems is often unclear. Thus, little is known about the occurrence and clinical impact of a failed prehospital diagnosis in a fully operational prehospital triage system.…”

Section: Introductionmentioning

confidence: 99%

Interhospital transfer due to failed prehospital diagnosis for primary percutaneous coronary intervention: an observational study on incidence, predictors, and clinical impact

Mahmoud

Nijsten

et al. 2013

European Heart Journal: Acute Cardiovascular Care

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Background: For patients with ST-elevation myocardial infarction (STEMI), guidelines recommend prehospital triage and direct referral to a percutaneous coronary intervention (PCI)-capable centre in order to minimize ischemic time. However, few have studied failed prehospital diagnosis. We assessed the incidence, predictors, and clinical impact of interhospital transfer for primary PCI after initial referral to a non-PCI-capable centre due to a failed prehospital STEMI diagnosis. Methods: We studied 846 consecutive STEMI patients undergoing primary PCI between January 2008 and January 2010. Results: We found that 609 patients (72%) were directly admitted through prehospital triage and 127 patients (15%) required interhospital transfer after failed prehospital diagnosis. Median first medical contact to treatment time was 88 min in the prehospital diagnosis group and 155 min in the interhospital transfer group (p<0.001). In the interhospital transfer group, the first available electrocardiogram was diagnostic for STEMI in 77% of cases. Predictors of interhospital transfer were female gender, diabetes, prior myocardial infarction, and greater event location to PCI-capable centre distance. Interhospital transfer independently accounted for a 47% increase in ischemic time (95% CI 33 to 63%; p<0.001). One-year mortality was higher in the interhospital transfer group (10 vs. 5.3%; p=0.030). Conclusions: Despite an often-diagnostic electrocardiogram, interhospital transfer after failed prehospital diagnosis occurred in 15% of STEMI patients undergoing primary PCI. Interhospital transfer was a major predictor of ischemic time and 1-year mortality was significantly higher. Continuing efforts to optimize prehospital triage are warranted, especially among patients at higher risk of failed prehospital diagnosis.

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“…The ECG remains the single most useful diagnostic test in cases of suspected ACS and facilitates segregation of patients into STEMI and NSTEACS pathways. (8). In NSTEACS, findings may be more variable and commonly include ST-segment depression and T-wave inversion.…”

Section: Electrocardiographic Manifestationsmentioning

confidence: 99%

Effect of Stress Hyperglycemia in Acute St Segment Elevation Myocardial Infarction

Hakeem¹

2017

IJMPS

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Impact of Prehospital Electrocardiogram Protocol and Immediate Catheterization Team Activation for Patients With ST-Elevation–Myocardial Infarction

Cited by 16 publications

References 27 publications

Impact of transport pathways on the time from symptom onset of ST-segment elevation myocardial infarction to door of coronary intervention facility

Impact of transport pathways on the time from symptom onset of ST-segment elevation myocardial infarction to door of coronary intervention facility

Interhospital transfer due to failed prehospital diagnosis for primary percutaneous coronary intervention: an observational study on incidence, predictors, and clinical impact

Effect of Stress Hyperglycemia in Acute St Segment Elevation Myocardial Infarction

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