title: Integration of pre-hospital electrocardiograms and ST-elevation myocardial infarction receiving center (SRC) networks: impact on Door-to-Balloon times across 10 independent regions.
abstract: 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.
authors.affiliation: Geffen School of Medicine at UCLA, UCLA-Olive View Medical Center, Department of Emergency Medicine, Sylmar, California 91342-1495, USA. irokos@earthlink.net
authors.forename: Ivan C
authors.initials: IC
authors.lastname: Rokos
authors.forename: William J
authors.initials: WJ
authors.lastname: French
authors.forename: William J
authors.initials: WJ
authors.lastname: Koenig
authors.forename: Samuel J
authors.initials: SJ
authors.lastname: Stratton
authors.forename: Beverly
authors.initials: B
authors.lastname: Nighswonger
authors.forename: Brian
authors.initials: B
authors.lastname: Strunk
authors.forename: Jackie
authors.initials: J
authors.lastname: Jewell
authors.forename: Ehtisham
authors.initials: E
authors.lastname: Mahmud
authors.forename: James V
authors.initials: JV
authors.lastname: Dunford
authors.forename: Jon
authors.initials: J
authors.lastname: Hokanson
authors.forename: Stephen W
authors.initials: SW
authors.lastname: Smith
authors.forename: Kenneth W
authors.initials: KW
authors.lastname: Baran
authors.forename: Robert
authors.initials: R
authors.lastname: Swor
authors.forename: Aaron
authors.initials: A
authors.lastname: Berman
authors.forename: B Hadley
authors.initials: BH
authors.lastname: Wilson
authors.forename: Akinyele O
authors.initials: AO
authors.lastname: Aluko
authors.forename: Brian W
authors.initials: BW
authors.lastname: Gross
authors.forename: Paul S
authors.initials: PS
authors.lastname: Rostykus
authors.forename: Angelo
authors.initials: A
authors.lastname: Salvucci
authors.forename: Vishva
authors.initials: V
authors.lastname: Dev
authors.forename: Bryan
authors.initials: B
authors.lastname: McNally
authors.forename: Steven V
authors.initials: SV
authors.lastname: Manoukian
authors.forename: Spencer B
authors.initials: SB
authors.lastname: King
mesh_terms: 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