title: Pre- and early in-hospital procedures in patients with acute coronary syndromes: first results of the "German chest pain unit registry".
abstract: BACKGROUND
  In an attempt to improve the treatment of patients with acute coronary syndromes (ACS), a network of certified chest pain units (CPUs) has been recently established in Germany.
  
  
  METHODS
  Data from patients admitted between December 2008 and September 2011 for ACS in 40 certified CPUs participating in the registry were prospectively collected.
  
  
  RESULTS
  A total of 5,457 patients was admitted for ACS; 798 patients (14.6 %) were diagnosed with an ST-elevation myocardial infarction (STEMI), 2,244 (41.1 %) with a non-ST-elevation myocardial infarction (NSTEMI), and 2,415 (44.3 %) with unstable angina. The mean time to first medical contact was 2:08 h for STEMI patients. A pre-hospital ECG was available in 23.8 % of all ACS patients. Importantly, evidence of ST-segment elevation was present in 79.7 % of the STEMI patients already in this pre-hospital ECG. As many as 76.6 % of the patients, independently of their symptoms and final diagnosis, received an ECG within 10 min of reaching the CPU. 98.2 % of STEMI patients underwent invasive diagnostics, with an in-hospital delay as little as 31 (11-75) min.
  
  
  CONCLUSIONS
  The establishment of a nation-wide network of certified CPUs optimizes the medical treatment of patients with ACS while providing an ideal infrastructure to evaluate and improve, both on a nation-wide and a single center scale, the adherence to guidelines. The median delay between symptom onset and first medical contact remains high. Although performed relatively rarely, a pre-hospital ECG facilitates earlier diagnosis of a STEMI in a large majority of patients. The introduction of CPUs minimizes in-hospital delays and exploits the benefit of invasive diagnostics and treatment.
authors: 2nd Department of Medicine, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany.
authors: Felix
authors: F
authors: Post
authors: Evangelos
authors: E
authors: Giannitsis
authors: Thomas
authors: T
authors: Riemer
authors: Lars S
authors: LS
authors: Maier
authors: Claus
authors: C
authors: Schmitt
authors: Burghard
authors: B
authors: Schumacher
authors: Gerd
authors: G
authors: Heusch
authors: Harald
authors: H
authors: Mudra
authors: Thomas
authors: T
authors: Voigtländer
authors: Rainer
authors: R
authors: Erbel
authors: Harald
authors: H
authors: Darius
authors: Hugo
authors: H
authors: Katus
authors: Christian
authors: C
authors: Hamm
authors: Jochen
authors: J
authors: Senges
authors: Tommaso
authors: T
authors: Gori
authors: Thomas
authors: T
authors: Münzel
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D000368:Aged; D000789:Angina, Unstable / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D002637:Chest Pain / Q000209:etiology*; D003325:Coronary Care Units / Q000458:organization & administration*; D004562:Electrocardiography; D005858:Germany; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D011785:Quality Assurance, Health Care; D012042:Registries; D013997:Time Factors