From door-to-balloon time to contact-to-device time: predictors of achieving target times in patients with ST-elevation myocardial infarction.
BACKGROUND
The 2013 American College of Cardiology Foundation/American Heart Association ST-segment elevation myocardial infarction (STEMI) guidelines have shifted focus from door-to-balloon (D2B) time to the time from first medical contact to device activation (contact-to-device time [C2D] ).


OBJECTIVE
This study investigates the impact of prehospital wireless electrocardiogram transmission (PHT) on reperfusion times to assess the impact of the new guidelines.


METHODS
From January 2009 to December 2012, data were collected on STEMI patients who received percutaneous coronary interventions; 245 patients were included for analysis. The primary outcome was median C2D time in the PHT group and the secondary outcome was D2B time.


RESULTS
Prehospital wireless electrocardiogram transmission was associated with reduced C2D times vs no PHT: 80 minutes (interquartile range [IQR], 64-94) vs 96 minutes (IQR, 79-118), respectively, P < 0.0001. The median D2B time was lower in the PHT group vs the no-PHT group: 45 minutes (IQR, 34-56) vs 63 minutes (IQR, 49-81), respectively, P < 0.0001. Multivariate analysis showed PHT to be the strongest predictor of a C2D time of <90 minutes (odds ratio: 3.73, 95% confidence interval: 1.65-8.39, P = 0.002). Female sex was negatively predictive of achieving a C2D time <90 minutes (odds ratio: 0.23, 95% confidence interval: 0.07-0.73, P = 0.01).


CONCLUSIONS
In STEMI patients, PHT was associated with significantly reduced C2D and D2B times and was an independent predictor of achieving a target C2D time. As centers adapt to the new guidelines emphasizing C2D time, targeting a shorter D2B time (<50 minutes) is ideal to achieve a C2D time of <90 minutes.
Department of Medicine, Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, New York.
Robert O
RO
Roswell
Brian
B
Greet
Parin
P
Parikh
Andrea
A
Mignatti
John
J
Freese
Iryna
I
Lobach
Yu
Y
Guo
Norma
N
Keller
Martha
M
Radford
Sripal
S
Bangalore
D000368:Aged; D016009:Chi-Square Distribution; D004562:Electrocardiography / Q000592:standards; D004632:Emergency Medical Services / Q000379:methods* / Q000592:standards; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000628:therapy*; D009519:New York City; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention / Q000295:instrumentation / Q000592:standards; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012189:Retrospective Studies; D013997:Time Factors; D061665:Time-to-Treatment; D016896:Treatment Outcome; D059015:Wireless Technology / Q000592:standards