Integration of pre-hospital electrocardiograms and ST-elevation myocardial infarction receiving center (SRC) networks: impact on Door-to-Balloon times across 10 independent regions.
OBJECTIVE
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 <or=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 <or=90 min (95% confidence interval: 84.4% to 87.4%). Secondary analyses of this cohort demonstrated a 50% rate of D2B <or=60 min (n = 1,031), 25% rate of D2B <or=45 min (n = 517), and an 8% rate of D2B <or=30 min (n = 155). A tertiary analysis restricted to 762 of 2,053 (37%) cases demonstrated a 68% rate of E2B <or=90 min.


CONCLUSIONS
Ten independent regional SRC networks demonstrated a combined 86% rate of D2B <or=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.
Rokos
Ivan C
IC
Geffen School of Medicine at UCLA, UCLA-Olive View Medical Center, Department of Emergency Medicine, Sylmar, California 91342-1495, USA. irokos@earthlink.net
French
William J
WJ
Koenig
William J
WJ
Stratton
Samuel J
SJ
Nighswonger
Beverly
B
Strunk
Brian
B
Jewell
Jackie
J
Mahmud
Ehtisham
E
Dunford
James V
JV
Hokanson
Jon
J
Smith
Stephen W
SW
Baran
Kenneth W
KW
Swor
Robert
R
Berman
Aaron
A
Wilson
B Hadley
BH
Aluko
Akinyele O
AO
Gross
Brian W
BW
Rostykus
Paul S
PS
Salvucci
Angelo
A
Dev
Vishva
V
McNally
Bryan
B
Manoukian
Steven V
SV
King
Spencer B
SB
D000552:Ambulances; D015906:Angioplasty, Balloon, Coronary; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration; D004562:Electrocardiography; D004632:Emergency Medical Services / Q000458:organization & administration; D019983:Guideline Adherence; D006297:Health Services Accessibility / Q000458:organization & administration; D006801:Humans; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000628:therapy*; D009937:Organizational Objectives; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D012041:Regional Medical Programs / Q000458:organization & administration; D012042:Registries; D013997:Time Factors; D014218:Triage; D014481:United States