Prehospital 12-lead ECG to triage ST-elevation myocardial infarction and emergency department activation of the infarct team significantly improves door-to-balloon times: ambulance Victoria and MonashHEART Acute Myocardial Infarction (MonAMI) 12-lead ECG project.
BACKGROUND
American College of Cardiology/American Heart Association guidelines recommend >75% of patients with an ST-elevation myocardial infarction receive primary percutaneous coronary interventions (PPCI) within 90 minutes. Despite these recommendations, this goal has been difficult to achieve.


RESULTS
We conducted a prospective interventional study involving 349 patients undergoing PPCI at a single tertiary referral institution to determine the impact of prehospital 12-lead ECG triage and emergency department activation of the infarct team on door-to-balloon time (D2BT). The median D2BT of all patients (n=107) who underwent PPCI after field ECG and emergency department activation of the infarct team (MonashHEART Acute Myocardial Infarction [MonAMI] group) was 56 minutes (interquartile range, 36.5 to 70) compared with the median time of a contemporary group (n=122) undergoing PPCI during the same period but not receiving field triage (non-MonAMI group) of 98 minutes (73 to 126.45). The median D2BT time of 120 consecutive patients who underwent PPCI before initiation of the project (pre-MonAMI group) was 101.5 minutes (72.5 to 134; P<0.001). The proportion of patients who achieved a D2BT of < or = 90 minutes increased from 39% in the pre-MonAMI group and 45% in the non-MonAMI group to 93% in the MonAMI group (P<0.001).


CONCLUSIONS
The performance of prehospital 12-lead ECG triage and emergency department activation of the infarct team significantly improves D2BT and results in a greater proportion of patients achieving guideline recommendations.
Hutchison
Adam W
AW
Monash Cardiovascular Research Centre, Monash University, Australia.
Malaiapan
Yuvaraj
Y
Jarvie
Ian
I
Barger
Bill
B
Watkins
Edward
E
Braitberg
George
G
Kambourakis
Tony
T
Cameron
James D
JD
Meredith
Ian T
IT
D000368:Aged; D000552:Ambulances / Q000458:organization & administration*; D015906:Angioplasty, Balloon, Coronary; D001315:Australia; D004562:Electrocardiography; D004632:Emergency Medical Services / Q000458:organization & administration; D004636:Emergency Service, Hospital / Q000458:organization & administration; D005260:Female; D019983:Guideline Adherence; D006297:Health Services Accessibility / Q000458:organization & administration; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000628:therapy; D010348:Patient Care Team / Q000458:organization & administration; D010865:Pilot Projects; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D015397:Program Evaluation; D011446:Prospective Studies; D013997:Time Factors; D014218:Triage / Q000458:organization & administration