Nationwide Improvement of Door-to-Balloon Times in Patients With Acute ST-Segment Elevation Myocardial Infarction Requiring Primary Percutaneous Coronary Intervention With Out-of-Hospital 12-Lead ECG Recording and Transmission
| Autor: | Venkataraman Anantharaman, Pin Pin Pek, Paul Jau Lueng Ong, Aaron Sung Lung Wong, Sea Hing Ong, Terrance Siang Jin Chua, Huihua Li, Marcus Eng Hock Ong, Shieh Mei Lai, Chong Meng Seet, Beng Leong Lim, Swee Guan Teo, Kim Poh Chan, Francis Chun Yue Lee |
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| Rok vydání: | 2013 |
| Předmět: |
Male
Emergency Medical Services medicine.medical_specialty Time Factors medicine.medical_treatment Ambulances Myocardial Infarction Chest pain Electrocardiography Internal medicine medicine Emergency medical services Humans cardiovascular diseases Myocardial infarction Angioplasty Balloon Coronary Adverse effect Singapore medicine.diagnostic_test business.industry Percutaneous coronary intervention Middle Aged medicine.disease Confidence interval Surgery Treatment Outcome Emergency Medicine Door-to-balloon Cardiology Female medicine.symptom business |
| Zdroj: | Annals of Emergency Medicine. 61:339-347 |
| ISSN: | 0196-0644 |
| DOI: | 10.1016/j.annemergmed.2012.08.020 |
| Popis: | Study objective Reducing door-to-balloon times for acute ST-segment elevation myocardial infarction (STEMI) patients has been shown to improve long-term survival. We aim to reduce door-to-balloon time for STEMI patients requiring primary percutaneous coronary intervention by adoption of out-of-hospital 12-lead ECG transmission by Singapore's national ambulance service. Methods This was a nationwide, before-after study of STEMI patients who presented to the emergency departments (ED) and required percutaneous coronary intervention. In the before phase, chest pain patients received 12-lead ECGs in the ED. In the after phase, 12-lead ECGs were performed by ambulance crews and transmitted from the field to the ED. Patients whose ECG showed greater than or equal to 2 mm ST-segment elevation in anterior or greater than or equal to 1 mm ST-segment elevation in inferior leads for 2 or more contiguous leads and symptom onset of less than 12 hours' duration were eligible for percutaneous coronary intervention activation before arrival. Results ECGs (2,653) were transmitted by the ambulance service; 180 (7%) were suspected STEMI. One hundred twenty-seven patients from the before and 156 from the after phase met inclusion criteria for analysis. Median door-to-balloon time was 75 minutes in the before and 51 minutes in the after phase (median difference=23 minutes; 95% confidence interval 18 to 27 minutes). Median door-to-balloon times were significantly reduced regardless of presentation hours. Overall, there was significant reduction in door-to-activation, door-to-ECG, and door-to–cardiovascular laboratory times. No significant difference was found pertaining to adverse events. Conclusion This study describes a nationwide implementation of out-of-hospital ECG transmission resulting in reduced door-to-balloon times, regardless of presentation hours. Out-of-hospital ECG transmission should be adopted as best practice for management of chest pain. |
| Databáze: | OpenAIRE |
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