Abstract 2075: Factors Influencing Door-to-Perfusion Times in ST Elevation Myocardial Infarct Patients Transferred for Primary Percutaneous Coronary Intervention: Impact of Pre-hospital ECG Diagnosis
Background: Delays related to diagnosis, triage and transport are major impediments to establishing universal inter-hospital transfer strategies for patients with ST elevation myocardial infarction (STEMI) presenting to hospitals without primary percutaneous coronary intervention (PPCI) capabilities. A coordinated inter-hospital triage and transfer program for STEMI patients has been established among 2 tertiary PPCI-capable hospitals and 6 community hospitals (CH) in a rural environment in central Illinois. Pre-hospital ECG acquisition is being utilized at one of these CH.
Methods: In this study we compared 5 specific triage and treatment time intervals of 6 (21%) STEMI patients who received pre-hospital ECG versus 22 patients whose diagnosis was confirmed in the emergency department (ED). Transport distance was 35 miles to PPCI-capable facility. The triage and treatment intervals examined among the 28 STEMI patients (mean age: 55 +/− 10 years), included: a.) door-decision (CH door-to-MI confirmation), b.) CH door-departure, c.) CH door-to-tertiary door, d.) tertiary arrival-TIMI 3 perfusion, e.) CH door-balloon time.
Results: Better Door-TIMI 3 perfusion rates at ≤ 90 minutes (50% v 5%; p= 0.035) and ≤ 120 minutes (100% v 45%; p=0.06) was achieved with pre-hospital ECG STEMI diagnosis.
Conclusion: These preliminary data suggest that utilization of pre-hospital ECG acquisition as an adjunct to coordinated STEMI triage and transfer algorithms significantly reduces transfer delays and is associated with a 30-minute reduction in overall Door-TIMI 3 perfusion time compared to standard ED diagnosis. Increased utilization of this technology could potentially enhance the clinical utility of STEMI transfer programs in rural environments.