Integration of Pre-Hospital Electrocardiograms and ST-Elevation Myocardial Infarction Receiving Center (SRC) Networks
| Autor: | Akinyele O. Aluko, Beverly Nighswonger, Paul S. Rostykus, William J. French, James V. Dunford, Jon Hokanson, Angelo A. Salvucci, Brian Strunk, Brian W. Gross, Robert A. Swor, Steven V. Manoukian, Vishva Dev, William Koenig, Spencer B. King, Samuel J. Stratton, B. Hadley Wilson, Stephen W. Smith, Aaron D. Berman, Ehtisham Mahmud, Ivan C. Rokos, Jackie Jewell, Bryan McNally, Kenneth W. Baran |
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| Rok vydání: | 2009 |
| Předmět: |
medicine.medical_specialty
medicine.diagnostic_test business.industry medicine.medical_treatment Percutaneous coronary intervention medicine.disease Internal medicine Cohort medicine Door-to-balloon Cardiology Emergency medical services cardiovascular diseases Myocardial infarction Myocardial infarction diagnosis Prospective cohort study business Cardiology and Cardiovascular Medicine Electrocardiography |
| Zdroj: | JACC: Cardiovascular Interventions. 2(4):339-346 |
| ISSN: | 1936-8798 |
| DOI: | 10.1016/j.jcin.2008.11.013 |
| Popis: | Objectives The aim of this study was to evaluate the rate of timely reperfusion for ST-elevation myocardial infarction (STEMI) with primary percutaneous coronary intervention (PPCI) in regional STEMI Receiving Center (SRC) networks. Background The American College of Cardiology Door-to-Balloon (D2B) Alliance target is a >75% rate of D2B ≤90 min. Independent initiatives nationwide have organized regional SRC networks that coordinate universal access to 9-1-1 with the pre-hospital electrocardiogram (PH-ECG) diagnosis of STEMI and immediate transport to a SRC (designated PPCI-capable hospital). Methods A pooled analysis of 10 independent, prospective, observational registries involving 72 hospitals was performed. Data were collected on all consecutive patients with a PH-ECG diagnosis of STEMI. The D2B and emergency medical services (EMS)-to-balloon (E2B) times were recorded. Results Paramedics transported 2,712 patients with a PH-ECG diagnosis of STEMI directly to the nearest SRC. A PPCI was performed in 2,053 patients (76%) with an 86% rate of D2B ≤90 min (95% confidence interval: 84.4% to 87.4%). Secondary analyses of this cohort demonstrated a 50% rate of D2B ≤60 min (n = 1,031), 25% rate of D2B ≤45 min (n = 517), and an 8% rate of D2B ≤30 min (n = 155). A tertiary analysis restricted to 762 of 2,053 (37%) cases demonstrated a 68% rate of E2B ≤90 min. Conclusions Ten independent regional SRC networks demonstrated a combined 86% rate of D2B ≤90 min, and each region individually surpassed the American College of Cardiology D2B Alliance benchmark. In areas with regional SRC networks, 9-1-1 provides entire communities with timely access to quality STEMI care. |
| Databáze: | OpenAIRE |
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