Transfer of Patients With ST-Elevation Myocardial Infarction for Primary Percutaneous Coronary Intervention
| Autor: | Simon Kouz, Eli Segal, Lucy J. Boothroyd, Richard J. Harvey, Peter Bogaty, Stéphane Rinfret, Kevin A. Brown, Yongling Xiao, Sébastien Maire, Dave Ross, Laurie J. Lambert, James Nasmith |
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| Rok vydání: | 2014 |
| Předmět: |
Adult
Male Patient Transfer Emergency Medical Services medicine.medical_specialty Time Factors Adolescent medicine.medical_treatment Bundle-Branch Block Myocardial Infarction Electrocardiography Young Adult Percutaneous Coronary Intervention St elevation myocardial infarction Physiology (medical) Internal medicine medicine Ambulance service Emergency medical services Humans cardiovascular diseases Myocardial infarction Aged Retrospective Studies Aged 80 and over business.industry Medical record Quebec Percutaneous coronary intervention Middle Aged medicine.disease Survival Rate DIDO Cardiology Female Core laboratory Cardiology and Cardiovascular Medicine business |
| Zdroj: | Circulation. 129:2653-2660 |
| ISSN: | 1524-4539 0009-7322 |
| DOI: | 10.1161/circulationaha.113.007130 |
| Popis: | Background— Interhospital transfer of patients with ST-elevation myocardial infarction (STEMI) for primary percutaneous coronary intervention (PPCI) is associated with longer delays to reperfusion, related in part to turnaround (“door in” to “door out,” or DIDO) time at the initial hospital. As part of a systematic, province-wide evaluation of STEMI care, we examined DIDO times and associations with patient, hospital, and process-of-care factors. Methods and Results— We performed medical chart review for STEMI patients transferred for PPCI during a 6-month period (October 1, 2008, through March 31, 2009) and linked these data to ambulance service databases. Two core laboratory cardiologists reviewed presenting ECGs to identify left bundle-branch block and, in the absence of left bundle-branch block, definite STEMI (according to both cardiologists) or an ambiguous reading. Median DIDO time was 51 minutes (25th to 75th percentile: 35–82 minutes); 14.1% of the 988 patients had a timely DIDO interval (≤30 minutes as recommended by guidelines). The data-to-decision delay was the major contributor to DIDO time. Female sex, more comorbidities, longer symptom duration, arrival by means other than ambulance, arrival at a hospital not exclusively transferring for PPCI, arrival at a center with a low STEMI volume, and an ambiguous ECG were independently associated with longer DIDO time. When turnaround was timely, 70% of patients received timely PPCI (door-to-device time ≤90 minutes) versus 14% if turnaround was not timely ( P Conclusions— Benchmark DIDO times for STEMI patients transferred for PPCI were rarely achieved. Interventions aimed at facilitating the transfer decision, particularly in cases of ECGs that are difficult to interpret, are likely to have the best impact on reducing delay to reperfusion. |
| Databáze: | OpenAIRE |
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