Abstract 1992: STEMI Receiving Centers Reduce Door to Balloon Times in Los Angeles County
INTRODUCTION: Pre-hospital electrocardiograms (Pre-ECG) performed by paramedics and first call responders have the potential to markedly reduce Door to Balloon Times for patients having an ST segment elevation myocardial infarction (STEMI). The purpose of this study was to compare outcomes among STEMI patients transported by paramedics who received a pre-hospital ECG with patients who arrived via self-transport.
METHODS: Consecutive data was available from four Los Angeles County hospitals that performed primary percutaneous coronary intervention (PCI) between January 1, 2005 and December 31, 2005. There were no formal diversion criteria for STEMI patients during the study period. STEMI Receiving Centers were verbally notified of a “STEMI” patient by paramedics calling in from the field and activation of the hospital PCI team was at the discretion of the emergency physician.
RESULTS: A total of 223 patients met enrollment criteria, of whom 132 (59%) received a Pre-ECG and 91 (41%) were self-transported. The majority were male (78%) and the mean age was 62 years. STEMI patient insurance status included Medicare 24.3 %, private 45.5 % and self pay 21.7 %. Time intervals from the ED to the cath lab were significantly shorter for Pre-Hospital ECG patients (Mean=64 minutes) in comparison to self-transport patients (Mean=77 minutes; p=.009). Similarly, Door to Balloon Time was 95 and 108 minutes for Pre-Hospital ECG and self-transport patients, respectively (p = 0.017).
CONCLUSIONS: STEMI Receiving Centers markedly reduced transport time to the cath lab as well as Door to Balloon Times in patients who had a pre-hospital ECG taken by paramedics as compared to patients who were self-transported to the hospital for a Primary PCI procedure. Adoption of mandatory pre-hospital ECG policy for STEMI patients who call 911 may markedly reduce time to treatment and mortality throughout the nation.