title: An approach to shorten time to infarct artery patency in patients with ST-segment elevation myocardial infarction.
abstract: We developed a regional strategy to decrease the time to percutaneous coronary intervention (PCI) for patients with acute ST-segment elevation myocardial infarction (STEMI). Protocols were created for paramedics and referring hospitals to identify and directly triage all patients with STEMI to a single PCI center. Time to PCI reperfusion and in-hospital mortality were assessed in 233 consecutive patients with STEMI. Ninety-minute initial hospital door-to-patent infarct artery was achieved in 58.3% of paramedic-diagnosed and directly triaged patients compared with 37.5% of "walk-ins" to the PCI hospital and with only 5.2% of those transferred from another hospital emergency department (ED; p <0.001). Overall in-hospital mortality was 2.1%, 0% in paramedic identified patients, and 0% in those walk-ins to the PCI hospital ED compared with 4.3% for those transferred from a referring hospital ED (p = 0.007). Paramedic diagnosis of STEMI and direct triage to a prealerted interventional hospital for primary PCI was associated with a high percentage of patients achieving <90-minute infarct artery patency. Substantial delays remained for those who presented initially to a non-PCI hospital ED despite the expedited protocol. In conclusion, this observational study suggests that wider use of paramedic electrocardiographic STEMI diagnosis and direct triage to a prealerted PCI hospital catheterization team may help improve outcomes of patients with STEMI.
authors.affiliation: The Heart Clinic of Southern Oregon and Northern California P.C., Medford, Oregon. bgross@rogueheart.com
authors.forename: Brian W
authors.initials: BW
authors.lastname: Gross
authors.forename: Kent W
authors.initials: KW
authors.lastname: Dauterman
authors.forename: Mark G
authors.initials: MG
authors.lastname: Moran
authors.forename: Todd S
authors.initials: TS
authors.lastname: Kotler
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Schnugg
authors.forename: Paul S
authors.initials: PS
authors.lastname: Rostykus
authors.forename: Amy M
authors.initials: AM
authors.lastname: Ross
authors.forename: W Douglas
authors.initials: WD
authors.lastname: Weaver
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D015906:Angioplasty, Balloon, Coronary / Q000592:standards; D003331:Coronary Vessels / Q000503:physiopathology* / Q000601:surgery*; D004562:Electrocardiography; D004634:Emergency Medical Technicians / Q000592:standards; D004636:Emergency Service, Hospital / Q000592:standards; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000503:physiopathology* / Q000628:therapy*; D015425:Myocardial Reperfusion; D015588:Observer Variation; D017410:Practice Guidelines as Topic; D012017:Referral and Consultation / Q000592:standards; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors; D014187:Transportation of Patients / Q000592:standards; D016896:Treatment Outcome; D014481:United States; D014654:Vascular Patency