title: Characterization and referral patterns of ST-elevation myocardial infarction patients admitted to chest pain units rather than directly to catherization laboratories. Data from the German Chest Pain Unit Registry.
abstract: BACKGROUND
  Direct transfer to the catheterization laboratory for primary percutaneous coronary intervention (PCI) is standard of care for patients with ST-segment elevation myocardial infarction (STEMI). Nevertheless, a significant number of STEMI-patients are initially treated in chest pain units (CPUs) of admitting hospitals. Thus, it is important to characterize these patients and to define why an important deviation from recommended clinical pathways occurs and in particular to quantify the impact of deviation on critical time intervals.
  
  
  RESULTS
  1679 STEMI patients admitted to a CPU in the period from 2010 to 2015 were enrolled in the German CPU registry (8.5% of 19,666). 55.9% of the patients were delivered by an emergency medical system (EMS), 16.1% transferred from other hospitals and 15.2% referred by a general practitioner (GP). 12.7% were self-referrals. 55% did not get a pre-hospital ECG. Compared to the EMS, referral by GPs markedly delayed critical time intervals while a pre-hospital ECG demonstrating ST-segment elevation reduced door-to-balloon time. When compared to STEMI patients (n=21,674) enrolled in the ALKK-registry, CPU-STEMI patients had a lower risk profile, their treatment in the CPU was guideline-conform and in-hospital mortality was low (1.5%).
  
  
  CONCLUSIONS
  CPU-STEMI patients represent a numerically significant group because a pre-hospital ECG was not documented. Treatment in the CPU is guideline-conform and the intra-hospital mortality is low. The lack of a pre-hospital ECG and admission via the GP substantially delay critical time intervals suggesting that in patients with symptoms suggestive an ACS, the EMS should be contacted and not the GP.
authors.affiliation: Zentrum für Kardiologie, Kardiologie 1, Johannes Gutenberg-University Mainz, Mainz, Germany.
authors.forename: Frank P
authors.initials: FP
authors.lastname: Schmidt
authors.affiliation: Zentrum für Kardiologie, Kardiologie 1, Johannes Gutenberg-University Mainz, Mainz, Germany.
authors.forename: Andrea
authors.initials: A
authors.lastname: Perne
authors.affiliation: Foundation Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Hochadel
authors.affiliation: 3rd Department of Medicine, University Hospital Heidelberg, Heidelberg, Germany.
authors.forename: Evangelos
authors.initials: E
authors.lastname: Giannitsis
authors.affiliation: Department of Cardiology, Angiology and Intensive Care Medicine, Vivantes-Klinikum Neukölln, Berlin, Germany.
authors.forename: Harald
authors.initials: H
authors.lastname: Darius
authors.affiliation: 2nd Department of Medicine, University Hospital of Regensburg, Regensburg, Germany.
authors.forename: Lars S
authors.initials: LS
authors.lastname: Maier
authors.affiliation: Clinic for Cardiology and Angiology, Municipal Hospital Karlsruhe, Karlsruhe, Germany.
authors.forename: Claus
authors.initials: C
authors.lastname: Schmitt
authors.affiliation: Institute for Pathophysiology, West German Heart and Vascular Center, University School of Medicine, Essen, Germany.
authors.forename: Gerd
authors.initials: G
authors.lastname: Heusch
authors.affiliation: CCB, Cardioangiologisches Centrum Bethanien, Frankfurt am Main, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Voigtländer
authors.affiliation: Department of Cardiology, Pneumology and Internal Intensive Care Medicine, Klinikum Neuperlach, Städtisches Klinikum München GmbH, Munich, Germany.
authors.forename: Harald
authors.initials: H
authors.lastname: Mudra
authors.affiliation: Zentrum für Kardiologie, Kardiologie 1, Johannes Gutenberg-University Mainz, Mainz, Germany; Deutsches Zentrum für Herz- Und Kreislaufforschung, Standort Rhein, Mainz, Germany.
authors.forename: Tommaso
authors.initials: T
authors.lastname: Gori
authors.affiliation: Foundation Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany.
authors.forename: Jochen
authors.initials: J
authors.lastname: Senges
authors.affiliation: Zentrum für Kardiologie, Kardiologie 1, Johannes Gutenberg-University Mainz, Mainz, Germany. Electronic address: tmuenzel@uni-mainz.de.
authors.forename: Thomas
authors.initials: T
authors.lastname: Münzel
mesh_terms: D006328:Cardiac Catheterization / Q000379:methods*; D002637:Chest Pain / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D017023:Coronary Angiography; D003325:Coronary Care Units; D004562:Electrocardiography; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007755:Laboratories, Hospital; D008297:Male; D008875:Middle Aged; D012017:Referral and Consultation; D012042:Registries; D000072657:ST Elevation Myocardial Infarction / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D015996:Survival Rate / Q000639:trends; D061665:Time-to-Treatment / Q000639:trends
keywords: Chest pain unit; Critical time intervals; Guideline adherence; Pre-hospital ECG; STEMI