Integration of Pre-Hospital Electrocardiograms and ST-Elevation Myocardial Infarction Receiving Center (SRC) Networks

Rokos, Ivan C.; French, William J.; Koenig, William; Stratton, Samuel J.; Nighswonger, Beverly; Strunk, Brian L.; Jewell, Jackie; Mahmud, Ehtisham; Dunford, James V.; Hokanson, Jon; Smith, Stephen W.; Baran, Kenneth W.; Swor, Robert A.; Berman, Aaron D.; Wilson, B. Hadley; Aluko, Akinyele; Gross, Brian W.; Rostykus, Paul S.; Salvucci, Angelo; Dev, V.; McNally, Bryan; Manoukian, Steven V.; King, Spencer B.

doi:10.1016/j.jcin.2008.11.013

Cited by 175 publications

(98 citation statements)

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“…There were 34 patients in the noncardiac admission group including postsurgery, respiratory failure, and 4 of the miscellaneous patients had cancer (n=2) and gastrointestinal symptoms (n=2). In comparison with patients admitted for noncardiac reasons, patients admitted for cardiac reasons had lower mortality rates in-hospital, at 30 days (2.0% versus 17.7%; P=0.012 for both) and at 1 year (6.1% versus 32.4%; P=0.002), and shorter LOS (3 [2, 7.5] versus 6 [4,9]; P=0.008), as well. Patients initially admitted for cardiac reasons also tended to have shorter diagnostic ECG-to-balloon In-hospital death, n (%) Outcomes of in-hospital STEMI patients split by pre-and postprotocol implementation are shown in Table 4.…”

Section: Methodsmentioning

confidence: 94%

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ST-Elevation Myocardial Infarction Diagnosed After Hospital Admission

et al. 2014

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Section: Methodsmentioning

confidence: 94%

“…2 Since then, time to treatment for STEMI patients at PCI hospitals has improved dramatically, in particular, for patients using emergency medical services (EMS) with access to prehospital ECGs. 3,4 …”

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confidence: 99%

ST-Elevation Myocardial Infarction Diagnosed After Hospital Admission

et al. 2014

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“…In 2006, the ACC launched an initiative to focus on standardized guidelines to improve in‐hospital reperfusion times 5. Since that launch, D2B times have drastically decreased and sex‐related disparities in D2B times have improved 27. A similar initiative that is focused on standardizing prehospital assessment would likely improve C2D times, mitigate disparities based on sex, and improve survival from STEMI.…”

Section: Discussionmentioning

confidence: 99%

Impact of Sex and Contact‐to‐Device Time on Clinical Outcomes in Acute ST‐Segment Elevation Myocardial Infarction—Findings From the National Cardiovascular Data Registry

Roswell

Kunkes

Chen

et al. 2017

JAHA

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BackgroundEmergent myocardial reperfusion via primary percutaneous coronary intervention is optimal care for patients presenting with ST‐segment elevation myocardial infarction (STEMI). Delays in such interventions are associated with increases in mortality. With the shift in focus to contact‐to‐device (C2D) time as a new perfusion metric, this study was designed to examine how sex affects C2D time and mortality in STEMI patients.Methods and ResultsClinical data on male and female STEMI patients were extracted and analyzed from the National Cardiovascular Data Registry from July 1, 2008 to December 31, 2014. A total of 102 515 patients were included in the final analytic cohort. The median C2D time in female patients with STEMI was delayed when compared to male patients (80 [65–97] versus 75 [61–90] minutes; P<0.001). The unadjusted mortality was higher in female patients when compared to male patients with STEMI (4.1% versus 2.0%; P<0.001). For every 5‐minute increase in C2D time, the adjusted odds ratio for mortality was 1.04 (95% CI, 1.03–1.06) for female patients with STEMI and 1.07 (95% CI, 1.06–1.09) for male patients (P for sex by C2D interaction=0.003).ConclusionsTo date, this is the largest analysis of STEMI patients that measures the impact of the new recommended C2D reperfusion metric on in‐hospital mortality. Female STEMI patients have longer C2D times and increased mortality. The disparity can be improved and survival can increase in this high‐risk patient cohort by decreasing systems issues that cause increased reperfusion times in female STEMI patients.

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“…1 Several strategies are recommended to optimize and shorten reperfusion times, including the use of prehospital ECGs and direct transport to a PCI-capable hospital while bypassing a hospital without PCI capabilities. [1][2][3][4] Furthermore, expecting PCI-capable hospitals to have their catheterization laboratories ready within 20 to 30 minutes of activation for a primary PCI procedure has synergistic effects on both emergency department (ED) and catheterization laboratory processes and is associated with a shorter ED evaluation phase before transport to the catheterization laboratory. 5 Along this spectrum, the recently updated 2012 European Society of Cardiology STEMI guidelines state that in the optimal situation, STEMI patients diagnosed with a prehospital ECG should be directly transported to the catheterization laboratory of a PCI-capable hospital, thereby bypassing the ED.…”

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confidence: 99%

Emergency Department Bypass for ST-Segment–Elevation Myocardial Infarction Patients Identified With a Prehospital Electrocardiogram

et al. 2013

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Background-For patients identified before hospital arrival with ST-segment-elevation myocardial infarction, bypassing the emergency department (ED) with direct transport to the catheterization laboratory may shorten reperfusion times. Methods and Results-We studied 12 581 ST-segment-elevation myocardial infarction patients identified with a prehospital ECG treated at 371 primary percutaneous coronary intervention-capable US hospitals participating in the Acute Coronary Treatment and Intervention Outcomes Network Registry-Get With The Guidelines, including those participating in the American Heart Association Mission: Lifeline program from 2008 to 2011. Reperfusion times with primary percutaneous coronary intervention and in-hospital mortality rates were compared between patients undergoing ED evaluation and those bypassing the ED. ED bypass occurred in 1316 patients (10.5%). These patients had a lower frequency of heart failure and shock on presentation and nonsystem reasons for delay in percutaneous coronary intervention. ED bypass occurred more frequently during working hours compared with off-hours (18.3% versus 4.3%); ED bypass rate varied significantly across hospitals (median, 3.3%; range, 0%-71% The unadjusted in-hospital mortality rate was lower among ED bypass patients (2.7% versus 4.1%; P=0.01), but the adjusted mortality risk was similar (adjusted odds ratio, 0.69; 95% confidence interval, 0.45-1.03; P=0.07). Conclusions-Among ST-segment-elevation myocardial infarction patients identified with a prehospital ECG, the rate of ED bypass varied significantly across US hospitals, but ED bypass occurred infrequently and was mostly isolated to working hours. Because ED bypass was associated with shorter reperfusion times and numerically lower mortality rates, further exploration of and advocacy for the implementation of this process appear warranted. Bagai et al ED Bypass in STEMI 353 Editorial see p 322 Clinical Perspective on p 359We evaluated the contemporary use of ED bypass at hospitals participating in the National Cardiovascular Data Registry (NCDR) Acute Coronary Treatment and Intervention Outcomes Network Registry-Get With The Guidelines (ACTION Registry-GWTG), including those participating in the AHA Mission: Lifeline program to delineate the uptake of this strategy in the United States, as well as its impact on reperfusion times for STEMI patients undergoing primary PCI. We also evaluated patient and hospital factors associated with ED bypass and investigated the association of ED bypass with in-hospital mortality rates. MethodsAll patients admitted with STEMI from the ACTION Registry-GWTG from July 1, 2008, to March 31, 2011, were included in the initial study population because this time frame encompassed revisions to the data collection form designed to capture expanded data elements of prehospital treatments and evaluation. The ACTION Registry-GWTG serves as a hospital data collection and evaluation mechanism for the AHA's Mission: Lifeline program and has been described previously.7 A diagno...

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Integration of Pre-Hospital Electrocardiograms and ST-Elevation Myocardial Infarction Receiving Center (SRC) Networks

Abstract: Ten independent regional SRC networks demonstrated a combined 86% rate of D2B

Cited by 175 publications

References 32 publications

ST-Elevation Myocardial Infarction Diagnosed After Hospital Admission

ST-Elevation Myocardial Infarction Diagnosed After Hospital Admission

Impact of Sex and Contact‐to‐Device Time on Clinical Outcomes in Acute ST‐Segment Elevation Myocardial Infarction—Findings From the National Cardiovascular Data Registry

Emergency Department Bypass for ST-Segment–Elevation Myocardial Infarction Patients Identified With a Prehospital Electrocardiogram

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