title: Association between prehospital electrocardiogram use and patient home distance from the percutaneous coronary intervention center on total reperfusion time in ST-segment-elevation myocardial infarction patients: a retrospective analysis from the national cardiovascular data registry.
abstract: BACKGROUND
  Current guidelines recommend ≤90 minutes from first medical contact to percutaneous coronary intervention (FMC2B) for ST-segment-elevation myocardial infarction (STEMI) patients. We evaluated the relationship between patient home distance from a percutaneous coronary intervention (PCI) center, prehospital electrocardiogram (ECG) use, and FMC2B time among patients with STEMI.
  
  
  METHODS
  We performed a retrospective cohort study including all STEMI patients in the ACTION-Get With The Guidelines registry from July 1, 2008, to September 30, 2012, who were transported by ambulance to a PCI center. Patient home distance was defined as the driving distance from the patient's home zip code to the PCI center address. Distance was classified into tertiles, and linear regression was used to characterize the interaction between prehospital ECG use and patient home distance with respect to FMC2B time.
  
  
  RESULTS
  Of the 29,506 STEMI patients, 19,690 (67%) received a prehospital ECG. The median patient home distance to the PCI center was 11.0 miles among patients with and 9.9 miles among those without a prehospital ECG. Prehospital ECGs were associated with a 10-minute reduction in the FMC2B time (P < .0001), which was consistent across distance tertiles (11 vs 11 vs 10 minutes). The association between prehospital ECGs and shorter FMC2B was attenuated by 0.8 minute for every 10-mile increase in distance (interaction P = .0002).
  
  
  CONCLUSIONS
  Prehospital ECGs are associated with a 10-minute reduction in the FMC2B time. However, patient home distance from a PCI center does not substantially change this association.
authors.affiliation: Department of Emergency Medicine, University of California Davis, Sacramento, CA. Electronic address: mummabe@gmail.com.
authors.forename: Bryn E
authors.initials: BE
authors.lastname: Mumma
authors.affiliation: Division of Cardiology, Virginia Commonwealth University, Richmond, VA.
authors.forename: Michael C
authors.initials: MC
authors.lastname: Kontos
authors.affiliation: Duke Clinical Research Institute, Durham, NC.
authors.forename: S Andrew
authors.initials: SA
authors.lastname: Peng
authors.affiliation: Department of Emergency Medicine, University of California Davis, Sacramento, CA.
authors.forename: Deborah B
authors.initials: DB
authors.lastname: Diercks
mesh_terms: D000368:Aged; D000552:Ambulances; D015906:Angioplasty, Balloon, Coronary / Q000706:statistics & numerical data*; D015331:Cohort Studies; D004562:Electrocardiography / Q000706:statistics & numerical data*; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D005843:Geography; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy*; D012189:Retrospective Studies; D061665:Time-to-Treatment / Q000706:statistics & numerical data*; D016896:Treatment Outcome